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was said to be hereditary, but it could not be born so ; theremust be some change in the blood producing blood-poisoning;the atheroma was the result of high tension. He had usedthe name excretory congestion because all the excretoryorgans, skin, &c., were affected. There was a distinctionbetween albumen from venous congestion and arterial alte-ration ; in venous albuminuria there was no guaiacum test,but in arterial albuminuria it was always present. Withthe assistance of Dr. Brunton, he had made the followingexperiment. A large dog was chloroformed and the urinetested; there was no guaiacum reaction. The aorta wasthen ligatured below the renal vessels; the next urinedrawn gave the blue reaction, and was alkaline. Inalbuminuria from lead-poisoning, as the lead is removedthe albumen disappears. The urine before albuminuria wasalways scanty, as far as he had observed.

Reviews and Notices of Books.Diseases of the Urinary Organs, including Stricture of the

Urethra, Affections of the Prostate, and Stone in the Bladder.By JOHN W. S. GODLEY, M.D., late Professor of ClinicalSurgery and Genito-Urinary Diseases in the MedicalDepartment of the University of the City of New York;Surgeon to Bellevue Hospital, &c. With 103 WoodEngravings. pp. 368. New York: W. Wood and Co.London: Triibner. 1873.

THE author of this work occupies, we believe, a high posi-tion in New York as an authority on genito-urinary dis-orders, and we are glad, therefore, to have the opportunityof comparing the views he entertains with those held on thisside of the Atlantic. Dr. Gouley is evidently fully aware ofall that is being done in regard to his special departmentboth in this country and on the continent, and it is inter-

esting to find that some of the conclusions he has arrivedat are just the reverse of those which have of late beensomewhat persistently urged upon the profession here.Thus Dr. Gouley emphatically lays down (p. 25) that gum-elastic catheters do not give less pain to the patient thanmetal instruments, and he himself always employs metalsounds for the larger sizes-i.e., above No. 7; and he says:" Patients, in taking note of the change of instrument, al-most always speak of the slight pain they feel during thepassage of the metallic, as compared with that produced bythe gum instrument." Dr. Gouley also prefers the recum-bent position for the patient upon whom a catheter is beingpassed.

Apropos of some recent teaching, we may quote the fol-lowing (p. 43) :-

" The surgical treatment is demanded in all the stages ofstricture, and without it internal medication is of little avail.This already well-known fact is here stated because thereare practitioners who still entertain the idea that if patientssuffering from obstructed micturition due to stricture be atonce put to bed, and treated medicinally, or even expec-tantly, they will soon get well. In answer to this, it maybe said that when patients make a good recovery under suchtreatment, they have not been suffering from stricture, butprobably from temporary obstruction in the deeper part ofthe urethra, caused by inflammatory swelling, which willfrequently subside by rest alone. Those who believe thatthey cure stricture in this way do not usually resort tourethral exploration, without which no diagnosis can be ac-cepted as conclusive."

In cases of tight stricture the author prefers slender

probe-pointed whalebone bougies, over which he slides hisown "tunneled sound" or an elastic catheter, thus follow-

ing Mr. Wakley’s practice. Treatment of stricture bycaustics and electrolysis are condemned, but the author hasa high opinion of 11 divulsion," or " splitting," as practisedby Mr. Holt. On this subject Dr. Gouley says (page 61) :11 Extensive experience has taught the profession that

nothing short of complete divulsion of the stricture will

ensure success, and that, after all, it amounts to about thesame thing as an internal urethrotomy ; but it is a saferoperation. Therefore Sir Henry Thompson’s precept of

stretching as much and tearing as little as possible might,well be reversed; and I will venture to say, tear as much andstretch as little as possible, and the results will be all the-better." Again, at page 83, the author says : " My ownpreference is now for divulsion, and I only resort to internalurethrotomy in intractable strictures of the ante-scrotal

portion of the canal."Both internal and external urethrotomy are recommended

by Dr. Gouley in suitable cases, and he has contrived aspecial grooved and tunneled staff for the latter proceeding.He regards it as an error to retain a catheter after eitheroperation. We need not, by the way, touch on the contro-versial correspondence between our author and ProfessorsVan Buren and Bumstead in regard to tunneled urethralinstruments.In discussing the subject of Retention of Urine, the

author refers to the old practice of treating retention dueto inflammatory swelling of the urethra in the followingterms (page 217) : " In former times, patients suffering inthis way were treated with opiates, hot baths, and leechesto the perineum, all of which are very good, but are cer-tainly insufficient to relieve the present distress. Promptand efficient succour is now given in these cases by the im-mediate use of the catheter, without any damage beingdone to the urethra, and is accomplished by the cautiousintroduction of a well-oiled No. 6 or 7 gum catheter."Somewhat energetic attempts have been made of late torevive the practice here condemned, but the published re-sults are not such as to recommend it.

Affections of the prostate are very briefly treated; andso also is the subject of stone in the bladder. The onlynovelty is the last chapter, which is devoted to a descrip-tion, largely illustrated, of the method of " perineal litho-trity" recommended by M. Dolbeau, of Paris. Dr. Gouleyseems to have a strong preference for this method, which,however, can be but rarely required. It consists in open-ing the membranous urethra from the perineum, and thendilating the prostate and neck of the bladder with a specialinstrument; after which a strong forceps or lithoclast is-introduced into the bladder, and the calculus broken intofragments sufficiently small to be readily extracted. Pro-

fessor Dolbeau seems to have had thirty operations, withfive deaths; and Dr. Gouley has had three successful cases-This practice would appear to be in direct opposition to themodern views respecting the non-dilatability of the neck ofthe bladder, and the necessity for free incisions throughthe prostate.

Practical Medicine, with a Sketch of Physiology and Thera-peutics. By ALEXANDER SILVFR,, M.A., M.D. London:Henry Renshaw.WHILE adopting the grouping of physiology, pathology,

and therapeutics, Dr. Silver asks that his new work on theold basis of " Meade’s Manual" may be judged as a bookon Practice of Medicine.As regards the part on Physiology, we need only point to

the page (34) on Bodily Heat, to show what a narrow linedivides condensation from confusion. The student who

accepts the normal temperature as 100°, and believes that" by adding to the diet oily substances" and " by wearingwarm clothing" he can in a healthy individual effect anincrease of bodily heat, will find his physiological experi-ments somewhat at fault.The part on Therapeutics, being but the epitome of an

ordinary materia medica, will be an unwelcome substitutefor the list of useful formulse which are usually appendedto handbooks on medicine.

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Dr. Silver prides himself in his preface on having avoided rectly speaking, which not to possess. It must be confessedthe "conventional divisions into diagnosis, prognosis," that, as far as general surgery is concerned, the student&c.; but it is not clear that his readers are gainers thereby. is perplexed rather than enlightened by the multiplicityTurning to the subject of phthisis, we find the opening of the sources of information; and, with the exception ofsentence of what would have been called diagnosis to be- fresh editions of the best standard works, he would proba-"two of the earliest signs of consumption are fever and bly be materially benefited by a strict prohibition againstemaciation;" "the fever which is described as hectic is the publication of a new work for many years to come.

peculiar." We should hope that the student will have We do not wish, however, to contest the raison d’gtre oflearned elsewhere to diagnose phthisis before the establish- Mr. Pirrie’s book.ment of Dr. Silver’s "earliest signs." When considering The best portions of the work are those in which practicalthe cough of phthisis it is said, " one troublesome feature surgery is dealt with, and these are undoubtedly well done.connected with this cough is its tendency to end in vomiting, The illustrations are also very good, and many are original.owingto the pressure of the stomach against the diaphragm"; The author has evidently devoted much time to the studybut no explanation is given of the cause of this unprovoked of the affections of the osseous system, considerably moreencroachment by the stomach in this disease. than one-third of the work being devoted to diseases andFrom the following very terse statements the student has injuries of this system, including of course the bones of the

to extract his knowledge of the moist sounds heard on aus- head and spine. The articles on the Fractures and Dislo-

cultation. " In the first stage, as soon as bronchial cations of the Femur are perhaps the best in the whole work,catarrh begins, we have moist bubbling riles of various and are really good. But in some other matters the author

kinds. In the second stage most of the above intensified. has adopted too fine a degree of subdivision in his classifica-But none of these indicate softening ; what does so is a thin tion ; as instances of which we may mention his descriptionmetallic bubbling, tending to become cavernous, &c." There of various kinds of ulcers, and his "bilious erysipelas ;’is here an opportunity for very delicate discrimination be- which is so called because bilious derangements precede thetween " moist bubbling riles of various kinds " and " thin inflammation of the skin.metallic bubbling." Under the head of treatment, cod- In the more scientific departments of surgery and patho-liver oil, of course, holds the first place; and, from an logy the author does not show to so much advantage. Tuber-author professing perspicuity and brevity, the following is culosis and struma are differentiated and yet combined inextraordinary: " Unfortunately its use is not so well under- such a manner as to render the descriptions of them con-stood ; it is not the giving of cod-liver oil, it is its digestion and fusing. Lupus, again, is remarkably involved. Lupus non.absorption which is desirable." In pneumonia, although exedens-is stated.to be synonymous with serpiginous ulcer ;,sweating is said to be " the most common critical pheno- and under the head of Lupus exedens rodent ulcer is de-menon," yet it is laid down that "sweating which proves scribed.so beneficial in bronchitis is useless in pneumonia, and so The work, moreover, in many places bears signs of hurriedare many remedies popularly believed to be efficacious." composition. For instance, the references to the writingsHaving vacillated between the terms "sunstroke" and of Drs. Williams, Addison, and Augustus Waller, in regard

"heatstroke," the author finally accepts both. "One we to migration of white blood-corpuscles in inflammation, aremight well call sunstroke; in such the patient falls, gives so confused that one is accredited with the publicationsone or two gasps, and dies," and is thus cavalierly disposed of the other. Another small fault is, that the "proofs"of. "The other, to which the term heatstroke is more have been carelessly read; for many names are incorrectlyapplicable, comes on more gradually. Heatstroke is essen- spelt in some places, but rightly in others. Further, in thetiallya condition of blood-poisoning where over-heated blood is article on Fracture of the Upper Jaw, which is so de-the poison." Why this curious piece of sophistry should signated in small capitals, the author, without any note orhave been gratuitously introduced we are at a loss to divine. explanation, describes fractures of the lower jaw and theirTo Dr. Silver’s practice we are indebted for the informa- treatment, neither of which are placed in the index.

tion that " in some cases nothing does so much good as ————————————

Epsom salts in full doses; in others this would speedily kill Phe Domestic Ma7tagement of Children. B P.M.B Epsom salts in full doses; in others this would speedily kill The Domestic Management of Children. ByP.M.BpAiDWOOD,the patient. M.D., Surgeon to the Wirral Hospital for Sick Children.The work appears to have been somewhat hastily com- London : Smith and Elder. 1874.

piled, and will hardly raise the author’s reputation. MATERNAL ignorance of the proper method of feeding.

The. .., of Surgery. By WILLIAM PIRRIE, clothing, and managing children is the source of a large part;

The Prtnctples and Practice Surgery By the University of infant mortality and adult infirmity. Some of it is due to.F.R.S.E., Professor of Surgery in the University of

sheer negl lect, but much is

not. The mothers mean well.Aberdeen. Third Edition. Illustrated by 498 Wood sheer neglect, but much is not. The mothers mean w:ell,..

Engravings. 8vo, pp. 977. London: J. and A. Churchill. but do not know what to do, or how to do it. The medical

1873. man has to instruct them, and to dispel much foolish pre-THE fact that a large work like the one before us has judice as well as ignorance. This reiterated instruction is-’

reached a third edition, is a sufficient guarantee that the very laborious, and often cannot be given efficiently byauthor has not been neglected by surgical readers, and word of mouth. A work which should convey the needed

would, under ordinary circumstances, justify us in merely information clearly and briefly, and yet in sufficient detail,.noticing some of the recent additions. But, as the author would be a useful aid to the hard-worked practitioner.states in his preface, " the present, as compared with pre- Dr. Braidwood’s little book does this fairly well. In aboutvious editions, may be considered a new work. More than eighty pages it contains chapters on the management of’nine-tenthsof the last edition have been entirely rewritten." children immediately after birth, the feeding of children,Under these circumstances we shall examine the work at other accessories to healthy development, and the manage-greater length than otherwise we should have felt called ment of children when sick. Extensive quotations fromupon to do. The author’s position is far too good to stand Dr. Combe make up a considerable part of the work; thein need of any indiscriminate praise. The number of works rest appears useful and accurate in its information, thoughwhich are being constantly placed before the profession is bearing some evidence of hasty composition. We missso great, that both student and practitioner must often be some suggestions which we should have expected to find inat a loss to decide which to possess, or perhaps more cor- it. In the account of suitable aperients so universal a

624

children’s medicine as rhubarb should not have been passedover without some allusion. In the description of thesymptoms of morbid states for which the mother is to beon the look out, there is no mention of the insidious earlysymptoms of rickets, which it is so important to recogniseand treat. The division of the frsenum of the tongue isspoken of as if it were an operation to be done by themother, in whose hands it would certainly not be so totallydevoid of danger as it is described. The whole work, smallas it is, might be condensed into still smaller compass.The more briefly necessary information can be given themore likely it is to be remembered and acted upon. As it

is, however, the book will be very useful, and deservesfavour with both the profession and the public. i

REPORTOF

The Lancet Sanitary CommissionON

THE DWELLINGS OF THE POOR.

No. I.

WE have for many months past had it in contemplationto issue a Commission to inquire into the condition of thedwellings of the working classes in the metropolis. Thedemands upon our space have of late been so unusuallygreat that we have been most reluctantly compelled topostpone the discussion of this very important topic till thepresent time. We regret the delay for this reason, that thesufferings of the poor are necessarily much less in the sum-mer than in the winter; and we should have preferred lay-ing before our readers a picture of the condition of the poorat the most trying rather than at the least trying time ofyear, feeling that by so doing we should have had a betterchanceof helping to stir upthedormant energies of the nationto take some decisive steps-steps worthy of a great peopleand -an enlightened age-for the complete abolition of acondition of things which in many parts of London is littlebetter than that in which the criminal classes wallowed a

century ago, and which then, by rousing the philanthropicspirit of Howard, brought about the reformation of theprison system in this and other countries.We have reformed our prisons, and in a great measure

we have reformed our workhouses. Latterly, Mr. Plimsollhas done, and is still doing, much for the amelioration ofthe condition of our sailors. Will nobody take upon himselfthe chivalrous task of battling with those " vested interests"and other obstacles which necessitate the continuation of a

great and crying scandal ? PMore than one deputation has already waited upon the

Home Secretary to impress upon him the necessity of theinterference of Parliament in this matter, and perhaps it isnot too much to hope that the present session may see theintroduction of a Bill for giving power to building societiesfor the acquisition, destruction, and reconstruction of thehouses in many parts of London. This power has been andis frequently and constantly given to railway companies.In Marcb, 1865, the Earl of Shaftesbury stated in the Houseof Lords that the houses for the demolition of which noticehad been given under the Bills before Parliament in thatsession amounted to 3500, containing a population of 20,000persons. This wholesale destruction of house property hasnot, it is believed, been accompanied by any correspondingexertion in the direction of building, and, as a consequence,the late occupants of the destroyed houses have been com-pelled to adopt one of two courses-either to squeeze them-

selves into houses already overcrowded, or else take ad-! vantage of the workmen’s trains, which are now tolerably, common, and live out of London. In adopting the first

course, they necessarily violate those rules of sanitation whichwe have long regarded as incontrovertible ; by adopting thesecond course they not only subject themselves to a con-siderable increase in their daily work and daily risks, but itwould appear in many instances they have, by removinginto the suburbs, managed to fix their habitations in a sortof no man’s land, where the most glaring breaches ofhygiene and of sanitary Acts of Parliament are allowed, ina great measure, to go unchecked.

Before commencing to deal with our subject in detail, itwould be advisable probably to give some slight sketch ofwhat has already been done for the improvement of thedwellings of the poor. In the very able report issuedtowards the close of last year by the Dwellings Committeeof the Charity Organisation Society the following summaryis given of the Acts affecting dwellings :-

1. The Common Lodging-houses Acts of 1851 and 1853enable the police in the metropolis to enforce sanitaryregulations in "common lodging-houses"-i.e., houses inwhich beds are let by the night.

2. The various Nuisance Removal Acts, the Sanitary Actof 1866, and the Artisans and Labourers’ Dwellings Act of1868, otherwise known as the McCullagh Torrens Act, em-body regulative provisions concerning the sanitary con-

dition of houses generally, with powers, in extreme cases,of closing and demolition.

3. The Metropolitan Building Act of 1855 prescribes theconditions of future construction with reference to everydescription of building agency within the metropolitanlimits; and the Labouring Classes Lodging-houses Act of1851 and the Labouring Classes Dwelling-houses Act of1866 enable local authorities to construct dwellings, and toborrow money from the Loan Commissioners at 4 per cent.The working of the Common Lodging-houses Act seems

to have been very effectual. "The common lodging-housesare reported to be superior to the average private lodgingsof the poor in cleanliness, in ventilation, and all sanitaryarrangements."

" It would be a great step in advance if the ordinarytenement houses occupied by the poor could have the benefitof similar regulations." It appears that the 35th section ofthe Sanitary Act of 1866 empowers local authorities to im-pose such regulations, subject to the approval of the LocalGovernment Board, on all houses let in lodgings, or occupiedby members of more than one family, not being "commonlodging-houses," as the police are empowered to enforceagainst the latter. "Frequent reference," says the reportabove referred to, "was made during the sittings of theCommittee to the desirableness of establishing a ‘ standardof habitability,’ below which no dwellings should be allowedto fall. The section (35th of Sanitary Act of 1866) referredto is perhaps the most direct attempt that has been madeto enable local boards to establish and maintain such astandard. The Committee have learned with regret thatnot only has this provision been sparingly adopted, but that,even where it has been adopted, serious difficulties have insome cases been encountered in applying it, owing partlyto technical defects in the regulations which renderedmagistrates powerless, and partly to want of determinationon the part of local authorities."We most thoroughly endorse the opinion expressed by

the Committee. There are thousands of houses in themetropolis, built perhaps a century ago, which, accordingto our modern notions, are hardly fit for the habitation ofa single family. These old houses are, many of them,crowded from cellar to garret with lodgers, and every room,or at most every floor of them, has become virtually aseparate tenement-a tenement without, in many case?, anadequate amount of light, air, or cubic space, and alwayswithout a proper or sufficient supply of water, without aseparate dust-bin, and without a separate sink. Thesedirty, dangerous tenement-rooms are often masked by theoutward look of respectability of the house which containsthem; and the saunterer in the London streets, who re-gards these houses as interesting relics of a past age, islitt’e disposed to think that everyone of them perhaps is1 ot entially a fever-nest. This report gives a list of thediff rent companies and agencies which have been employedin the metropolis in improving the dwellings of the 11 weekly-