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Mr. Selwood, assistant house-surgeon to the hospital, will beread with much interest. They bear on the question of thetreatment of compound fracture, with injury to an artery ofsome size, by primary or immediate amputation. There canbe no doubt that the plan pursued was the most conservativemeasure under the circumstances. The dissection of the limband the stump adds to the general value of the details.James S-, a brewer’s drayman, aged thirty one, in the

habit of drinking ten or twelve quarts of beer daily for the lastten years, was admitted on August 17th last, with a compoundcomminuted fracture of tibia and fibula, just below the knee.from direct violence, coupled with considerable contusion ofthe whole leg. The man was in a state of semi-consciousness,owing partly to "shock," and partly to the influence of drink.Blood was oozing from two wounds, one on either side of thetubercle of the tibia. His worsted sock was saturated, and hisboot soaked with blood on withdrawing it. Although the legwas much swollen and very tense, within a quarter of an hourafter the accident, yet the crepitus communicated by the frac-ture of both bones could be readily detected. No pulsationcould be felt in the dorsal artery of the foot, and its tempera-ture was sensibly lower than that of the other foot. A tour-

niquet was placed on the femoral artery; but the hæmorrhagestill continued after three or four hours had elapsed, the legmeanwhile becoming more swollen and cold. During this time,however, reaction gradually supervened ; the man quite reco- vered his consciousness, and his skin became warmer. Mr. Gant regarded the persistent haemorrhage and increasing ’,

coldness of the injured extremity as being critical circumstanceswhich warranted immediate amputation ; while the reactionoffered a favourable opportunity. Accordingly he then ampu-tated the thigh in its lower third by the flap operation, andwith but little loss of blood.The patient went on most satisfactorily for three days. The

stump-a large and fleshy one-was in a remarkably healthycondition. Primary union might be almost said to have sealedtogether the lips of the flaps throughout the greater portion oftheir extent; when, on the third day, towards evening, anagitated manner bespoke approaching delirium tremens. Hewas allowed a still larger quantity of stout (his usual stimu-lant) with opiates, but he became perfectly furious. He ravedfor two days with scarcely any intermission, and then, quiteexhausted, died suddenly.Mr. Gant dissected the leg and stump. There was a com-

pound and comminuted fracture of the tibia just below its an-terior tubercle; also fracture of the fibula, an inch below itshead;and extensive laceration of the extensor muscles, particularlyof the tibialis anticus, of which the upper half was thrown in-wards over the tibia, forming a considerable projection duringlife, immediately after the accident. The anterior tibial arterywas torn across at its commencement. The anterior tibialnerve, however, and the musculo-cutaneous nerve, were notinjured. The flaps of the stump were adherent throughouttheir extent, and required some slight force to separate them ;then, as the surfaces gave way, ductile films of lymph wereseen crossing between them. There was no pus. The main

artery enclosed a coagulum an inch and a quarter in length,which extended up to where a small vessel-the first-wasgiven off, and here the coagulum terminated abruptly. Justabove and below the ligature, the lining membrane, or innercoat, of the artery was divided and turned inwards, forming akind of fringe. The companion vein of this main artery alsocontained a coagulum of about the same extent as that in theartery, but the greater portion of this venous coagulum layabove a large valve, which formed a pouch across the area ofthe vessel. These coagula had formed in the course of fivedays- a fact which, together with the other particulars of theabove dissection, make an interesting contribution to patho-logical surgery.

THE MICROSCOPIC AND READING LAMP.-Amongst theinventions of the present season specially deserving notice, wemay mention a lamp manufactured by M. Pillischer, of NewBond-street. Of elegant appearance, it would form no un-

pleasing addition to the furmture of a drawing-room, thoughnominally a students’ and microscope lamp. It burns colzaor other oils, and is extremely simple in construction ; in fact,it is an improvement on the Argand lamp, the oil supplyingitself with greater regularity to the wick. It sheds a brilliantand steady light, the amount of which may be regulated atpleasure. It is economical, and can be readily cleaned whenrequired. For the microscopist and student it possesses ad.vantages that merit our cordial recommendation.

Reviews and Notices of Books.De la Contagion Syphilitique. Thèse pour le Doctorat en Mide.

cine. Par J. ALFRED FOURNIER. Paris, 1860.THIS is a thesis by one of Ricord’s favourite pupils, already

well known by the able manner in which he edited his master’slectures, and by several monographs on syphilis, amongstwhich may be mentioned one on the Contagion of Chancre,and another on the Cephalic Sore.The author in the present essay strives, first, to prove, by

facts, that an individual suffering from syphilis must some timeor other have had a chancre. His figures are certainly startling.In a first series of cases he found that out of S26 cases of second.

ary and tertiary syphilis, treated at the Venereal Hospital ofParis in 1856, the chancre, as an initiatory symptom, had existed815 times. The 11 cases in which no primary sore conld bemade out are disposed of in various ways, the least satisfactorybeing to suppose that lads of 18 and 25 were suffering fromhereditary syphilis. In a second series, obtained later, 22;r menand 79 women were observed. 198 men were suffering fromsecondaries, and in all these the chancre was traced; out of 22tertiary men, the sore was made out 20 times. With thewomen the investigation was not so successful ; nor is this tobe wondered at when the structure of the female organs isconsidered.There can be no doubt that these figures are extremely use.

ful; but we submit that, whilst they certainly prove the exist-ence of a rule, they also plainly show the existence of excep.tions. But what of that ? Is it not sufficient for all practicalpurposes to know that, in the immense majority of cases, &

chancre is the first symptom? The author wishes this to be

accepted as a law. This term is too ambitious ; but the valueand practical interest of the facts collected remain undoubted.Chancre being then most frequently the initiatory symptom,

the author next endeavours to establish the following proposi.tion : " The nature of a symptom arising from contagion is re-gulated by the nature of the symptom from which it arises."At first sight this seems too sweeping, and conveys more

than the author wishes; for in the preceding chapters asccondary symptom is shown to produce by contagion, nota secondary symptom, but a chancre. But the matter is quitecleared up in the sequel, and we find the following propositionsdefended and supported by facts and arguments:-

1. " A simple non-infecting chancre produces its like upon &

person free from any anterior syphilitic taint." Here the

author quotes an experiment rarely performed--namely, thepublic inoculation of a simple chancre upon a hitherto healthymedical man, who wished to subject himself to the trial. Asoft chancre was the result, and no syphilis occurred for atwelvemonth.

2. "A simple chancre transmitted to a syphilitic subjectremains a simple chancre."When he comes to the propagation of the infecting chancre-

namely, the one which engenders syphilis-the mode of con-tamination is found by the author to be more complex. His

opinion will be best understood by quoting the propositions :-1. "An infecting sore may be derived from a sore of the same

nature. "

2. " It may also arise from a simple sore (one with a softbase) with which a syphilitic individual is affected."

3. "It may be the consequence of the contagion of a secondarysymptom." Here M. Fournier establishes a distinction whichis very important : he, namely, contends that such secondariesas do not present humid or suppurating characters are notlikely to propagate the disease.

’

The author finds fault with the term "mucous tubercle" or

"patch," as applied to the secondary manifestations of mucous, membranes; and thinks that the terms (1) "mucous papule,"(2) "flat secondary ulcer," and (3) "deep secondary ulcer,’

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should be used when the mucous membrane (1) is merelyraised, a white aphthous elevation being the result; (2) whenit is simply abraded; and (3) when it is deeply ulcerated.As to the transmission of certain peculiarities of sores-as,

for instance size, appearance, duration, &c. -the author thinksthat no relation exists between the original symptom and themanifestation therewith transmitted. Very mild secondariesmay give rise to most dangerous ulcerations, whilst a phagedenicsore does not necessarily produce one of the same nature.

Herein we fully agree with the author.The last article in this highly interesting thesis relates to

the mode of lessening the ravages of the disease. The result

of the discussion in o which the author enters is, that femalesleading an irregular life should be examined two or three timesa week, instead of once.

This excellent mouograph is full of important facts andsound reasoning, and testifies to a most intimate knowledge ofthe disease itself and the questions bearing upon its pathology.All the problems are not solved as yet; but M. Fournier’s re-searches on Contagion are extremely valuable, and have beenalready extensively used by different authors.

Smith’s Visiting List, for 1862.

THIS is the sixteenth annual issue of this most compact anduseful publication, and fully maintains the character which theformer editions have justly acquired.

BLEEDING VERSUS BRANDY.

J. T. MITCHELL, F.R.C.S.

To the Editor of THE LANCET.

SIR,-On the Ilth inst. I had the privilege of being presentat the discussion of the Hunterian Medical Society of London,when Mr. Solly introduced the subject of "Bleeding;" and Ican truly say that no discussion has ever more deeply interestedme or given me more pleasure and satisfaction, because of thevast importance of the subject, and of the necessity which atthis time exists for restoring attention thereto,-and of thecalmness, moderation, and judgment observed by the speakers.

In the present perverted state of opinion relating to bleeding,this justly eminent and sober-thinking surgeon and pathologistdid well in selecting this topic, considering how almost univer-sally this active, safe, and useful remedy has been set aside-so much so that in some circles it is almost unknown,-andhow much and how injudiciously brandy and wine have beensubstituted.Mr. Solly " set the ball rolling" by a few judicious, plain,

and practical observations, and then gave several valuable- cases illustrative of the great advantage which he had seen asthe result of spontaneous epistaxis, and other bleedings effectedby Nature for her own relief, as well as from bleedings bene-ficially employed by himself and others, which had producedthe most palpable benefits that could not be controverted.Then came the truly valuable remarks of that exrensively en-gaged, that eminent and sage pathologist, Dr. Billing, whichwere followed by those of Mr. Curling, Dr Bennett, Dr. L.ittle,Mr. John Adams, and others-all men of first class eminence,of known good judgment, and whose opinions deserve the

highest respect. These all agreed that whilst brandy was amost valuable item in the Materia Medica, and could not bedispensed with as a remedy on truly legitimate occasions, yetthe lancet and leeches were remedial means equally valuable,-and could not be set aside except with very serions detrimentin many cases suffering under severe congestions, or in thefirst stages of acute inflammation;-sentiments perfectly cor-rect, and strongly borne out by my own experience, gained in- a large public practice in the parish of Lambeth, in which Ihave never done without the lancet, although I have often notused it for six months together; and when I have bled, it hasbeen done under the guidance of the wise axiom included inthe motto " Medio tutissimus ibis;" and in cases were activeand disorganizing inflammation had begun, " Prompte nontemere." It was the first occasion on which I had been presentat the meetings of the Hunterian Society, and it was my inten-tion, after having listened to the sentiments of those gentlemen,

to have given the result of my own practice in bleeding inpuerperal peri ouitis; but the hour of closing the discussionhad arrived when Mr. Solly was called to reply, and my oppor-tunity passed hy; but now, as I expect you will be requested topublish an epitome of the discussion, I hope you will find aplace for these remarks.

In the course of nearly forty years I have recorded more than4500 cases of midwifery that have occurred in the district ofthe parish to which I was attached as medical officer, amongstwhich I have been called to treat 27 cases of puerperal peri a

tonitis, all of the most formidable character, 23 of which per-fectly recovered, and 4 died. Those which died were all con-nected with peculiar and aggravated circumstances, or hadsuffered very severe lesions in labour. Every one of these 27cases, except one of those which died, were bled from twelveto sixteen ounces, most of them once only, and others to asmaller extent a second time, but all within two hours afterthe shivering fit, which invariably ushered in the disease. Theafter-treatment consisted in giving opium to almost a narcotizingeffect, and in applying extensive potent irritation over thewhole abdominal surface.These results prove that even a disease which is almost uni-

versally fatal when ordinarily treated is yet under the controlof the lancet, when used early enough after the first onset ofits formidable symptoms, and that bleeding ought not to be socompletely ignored as it is in modern practice, for which nosubstitute can be found.

I remain. Sir. vours. &c..Clapham-road, Dec. 1861.

THE TRANSMISSION OF SYPHILIS BYVACCINATION.

W. B. KESTEVEN, F.R.C.S.

To the Editor of THE LANCET.

SIR,-Allow me to thank you for your recommendation tothe treatise by M. Rollet, for the evidence of the possibility ofthe transmission of syphilis by vaccination. At the same timeI would state, that when I received your journal, on the dayof its publication, I was engaged in the study of that section ofthe " Recherches Cliniques et Experimentales sur la Syphilis,"by M. Rollet, which treats of the question. I have also care.fully read the papers, by M. Viennois, on the same subject, inthe Archives Générales de Médecine, 1860; and am bound toadmit that those works have supplied the proofs I asked, insupport of your own statement, that the transmission of syphilishad occurred in some rare instances.The few examples, authenticated by these writers, differ in

the most essential points from the narrative published in theGaz. dell’Asso. Med. They give exact details as to the sourceof the poison in each case ; whereas the history of the chargedtube mentioned in the Italian story is left altogether in thedark. On this, the very starting point of the whole series of £events, we are left to conjecture whether the syphilitic virusfound its way into the tube by accident or from intention.

After the perusal of the mbove-mentioned works, I have notmuch difficulty in explaining why such grave accidents shouldhappen. When I find the inoculation of healthy individualswirh the matter of chancre practised without compunction!and vaccine lymph inserted without any regard to the consti-tution whence it is derived, and totally irrespective of the dateor condition of the vesicles ! then I think 1 see a reason whysuch melancholy occurrences are not fa niliar to ourselves.

I remain. Sir. your obedient servant.

1::pper Holloway, Dec. 24th, 1861.

PHRENOLOGICAL EXAMINATION OF GA.RIBALDI.-TheItalian hero was born at Nice, and is now fifty two years old;he is a little more than five feet high. His head is very large,and in keeping with the bulk of the body. He measures roundthe shoulders forty-one inches, but in a straight line sixteeninches. The circumference of the head below is twenty-oneinches, and twenty inches above. From one meatus audi-torius to the other, running over the vertex, thirteen inches.From the root of the hair to the chin, eight inches; across theface, six inches. The intellectual qualities are more markedthan the affective ; amongst the latter, which are composed ofinstincts and feelings, the feelings predominate. Amongst theintellectual gnalitit-s, which are divided into perceptive and re-flective, the latter have the supremacy. His temperament isthe nervo-sanguine; hence he is the possessor of genius andactivity.-Gaz. Med. Ital, and Gaz. Méd. de Paris.