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- infinity risk from fire ; for the gas, unlike the water, didnot show itself, but found its way up the back of the plasterto the roof, or passed under floors and even into chimneys.In concluding, the author said he considered it of theutmost importance that the managers of every hos-

pital and asylum should possess an accurate plan ofthe sewers, drains, and other sanitary arrangements ofthe institutions under their charge. Without that heknew from experience that alterations made to remedy evilsoften multiplied and aggravated them, and as one genera-tion of officials passed away so did much valuable know-ledge, unless it was carefully recorded on an accurate plan.Of late years public attention had been thoroughly arousedto the dangers of defective sanitary conditions in privatehouses. Sanitary inspectors had been appointed, sanitaryassociations formed, and sanitary institutions established;engineers and plumbers vied with each other in the con-trivance of clever sanitary appliances ; even architects werebeginning to recognise the fact that their customers nowadays sactually expect that a house shall be a healthy dwelling :and it was not too much to expect that the medical pro-fession, which had always led the van in sanitary reform,should require that their patients, when congregated togetherin large numbers under one roof, should have the full ad-vantage of those healthy surroundings which were con-sidered so important in private dwellings.The members of the Association were afterwards enter-

tained to dinner by the directors of the asylum, when- between fifty and sixty gentlemen sat down, Dr. Howden.presiding.

Reviews and Notices of Books..A Manual of Surgery. In Treatises by Various Authors.

Edited by FREDERICK TREVES, F.R.C.S., Surgeon to, and’Lecturer on Surgery at, the London Hospital. In ThreeVolumes. London: Cassell and Co. 1886.

THE three small, handy volumes of which this workconsists are the result of the labours of no less than thirty-three writers, including the editor. All of them are surgeonsmore or less known to the profession as authorities on thesubjects of which they treat, or whose names are guaranteesof the excellence of the treatises written by them. Thevolumes contain about six hundred pages, and each is thesize of the clinical manuals issued by the same firm of

publishers. From the size of the volumes it has evidentlybeen difficult for the writers to limit their treatises to thenumber of pages allotted to them; some of the treatises, infact, appear to be abridged from works already written bythe authors, which occupy the space of one of the volumesof the Manual. The title of the work is somewhat misleadinguntil the preface has been read. There it is stated that"the three volumes of which it is composed are concernedmainly with the clinical, diagnostic, and therapeutic aspectsof surgery. The general principles of operative surgery aredealt with, but the technical details of the various pro-cedures are omitted, with the exception of such as concernwhat may be called special operations-namely, tracheotomy,gastrostomy, nephrectomy, ovariotomy, and the like. Insimilar manner, pathology is discussed only in so far as itaffects the clinical phases and the intelligible treatment ofsurgical disease." As this is a Manual of Surgery intendedfor the use of the student and the practitioner, it would havebeen better to have included information regarding the opera-tions ordinarily required sufficient to have enabled the formerto pass his examinations and prepare himself for practice,and the latter to go for reference when in any doubt as tothe special operative treatment of any particular case underhis care. As it is, the use of this Manual must be supple-mented by at least two others-one on pathology and theother on operative surgery. Looking at the work from thestandpoint given in the preface, we acknowledge that thetreatises are well, though unequally written, as might be-expected. Indeed it would be almost impossible to find at

present any ’work in which the subjects treated of arewritten more clearly or concisely.The first volume contains treatises on the process of £

repair, general injuries and their results, wounds, con-

tusions, abscesses, ulcers, gangrene, the general principlesof operative surgery, anaesthesia, shock, tetanus, erysipelas,pyaemia and septicaemia, traumatic fever, hectic, gunshotwounds, the effects of heat, traumatic delirium, hysteria,scrofula and tuberculosis, rickets, hoemophilia, syphilis,gonorrhoea, tumours, injuries and diseases of bloodvessels,aneurysm, injuries and diseases of the lymphatics andnerves, surgical affections of the skin, scurvy, and animalpoisons. The first paper is on the process of repair. Itcontains also a short account of the germ theory and thegeneral principles of antiseptic treatment. It is clearlywritten, with the exception of the following paragraph,which requires alteration, as in its present form it hardlyconveys the right impression :-" An injury is the result ofthe application of an irritant. The irritant may be applieddirectly to the part or indirectly. In the latter case it acts

through the nervous system. For example, abscess of oneof the cervical glands may result directly from a twist orstrain of the neck, or indirectly from the irritation of acarious tooth, one of the commonest causes of abscess in thatregion. Or, again, a swollen testicle may result directly froma blow, or indirectly from a gonorrhaea." The italics areours. Ten pages only are given to the general principles ofoperative surgery, which is treated of in a practical manner.We wish it had been a longer paper. Surely it is hardlynecessary to devote nearly six pages in the third volume tothe subject of extraction of teeth, when only ten are givento such a wide subject as operative surgery. The paper onanaesthesia is complete, and we agree in the main with theauthor, but advise the use of ether in routine practice forthe adjustment of fractures. Those on syphilis, tumours,injuries and diseases of the bloodvessels, and aneurysm aregood and practical, the one on the circulatory system beingespecially clear and well arranged. The absence of illustra-tions in the article on tumours detracts from the value ofthe paper, and contrasts with the article on animal poisonsat the end of the volume, where there are several. The

part which treats of injuries and diseases of the lymphaticand nervous systems will be read with pleasure. In thelatter is a good account of Charcot’s disease.The second volume treats of fractures, but we note

that fractures of the skull, spine, and ribs are dealt within the injuries of the special regions to which they belong.The author dwells upon the treatment of fractures of thelower extremity by plaster-of-Paris splints; this is im-

portant, as they are coming into such general use. Diseasesof the bones occupy about fifty pages; we dissent from theauthor, however, when he says that in the osseous lesions ofcongenital syphilis local treatment is uncalled for, the treat-ment by splints being so often necessary to give the partrest, and to prevent deformity. Injuries of joints, includ-ing dislocations, and diseases of the joints, take up spacewhich is carefully and well utilised. In the description ofthe latter the author discusses some of those affections ofthe joints usually described as medical-e.g., gout and rheu-matism,-which are apt to be forgotten by the practitionerwhen they affect one of the larger joints. Several of theillustrations in the work might with advantage be omictedin the next edition, and this remark applies especially to onewhich is found in the article on orthopaedic surgery, " TalipesCalcaneus : the Foot before and after section of the TendoAchillis." It is misleading and confuses the student, who wouldbe apt to get the impression that that is the proper treatmentof the deformity. Injuries and diseases of the head, spine,and neck are discussed, and the volume ends with papers ondiseases of the nose, ear, and eye, which are tersely andwell described. We notice that the author of the paper on

170

diseases of the neck arranges goitre into congestive andneoplastic, not following the usual classification.

In the third volume we find clearly written treatises onthe surgery of the chest, affections of the mouth, palate,tongue, and tonsil (the latter opens with a clear descriptionof the way in which malformations of the mouth and neckarise), diseases of the jaws, dental surgery (in which articlewe should like to have found more information regardingthe temporary treatment of painful conditions so often met-with in general practice), injuries and diseases of the

oesophagus and abdomen, hernia, diseases of the rectum,breast, genito-urinary organs, and kidney. The treatise onhernia is thoroughly and clearly put together; that on thefemale generative organs, one of the articles written by theeditor, is marked by characteristic excellence. The other

articles, especially that on the kidney, contain in a con-densed form the latest views on the subject, both from a Iclinical and an operative standpoint, and in that on the ’kidney the author is permitted to describe the operativetreatment of the diseases on which he has already written.At the end of each volume there is a short index, that

at the end of the third including those of the first twovolumes. The editor has had a difficult task to accom-

plish in the production of this work, and we congratu-late him on the successful result.

OUR LIBRARY TABLE.

A Manual of Medical Jurisprudence. By ALFRED SwmNFTAYLOR, 12.D., F.R.S. Eleventh Edition. Edited by THOMASSTEVENSON, M.D. Lond. Pp. 837. London : J. & A. Churchill.1886.-That the above manual has reached the eleventhedition is in itself trustworthy evidence of its intrinsic meritand the favour in which it is held by the profession. Thelamented death of its illustrious author has necessitated thatthe work of revision should fall into other hands, and, fortu-nately, the publishers have been able to secure the aid ofDr. Stevenson, whose practical acquaintance with the sub-ject, especially in its toxicological aspect, is recognised andappreciated by practitioner and student alike. The style ofthe book remains unaltered, but many passages have beencondensed, obsolete ones have been omitted, and "muchadditional matter has been introduced." We notice a

succinct account of the Lamson case of poisoning byaconitine. Had the edition been delayed in its appear-ance for a short time, it would doubtless have con-

tained a history of the trial (reported in this journal)which recently took place at the Old Bailey, where twopersons were indicted for having compassed the death ofa third by means of liquid chloroform. In the List ofCases Cited," a ready aid to the reader, as it is separate fromthe general index, no mention is made of the "Euston-square l2ystery." This is to be regretted, since the case,amongst other features of forensic interest, furnishedvaluable evidence on the question of personal identity.From a careful perusal, we can say without hesitationthat we know of no similar work in our own or anyother language in which the practical as distinguishedfrom the theoretical aspect of the study of medical juris-prudence is handled with the same aim and attainment.The description of the methods of procedure to be followedfor the collection and rendering of evidence is especiallygood.What is C’’onsumption ? By G. W. HAMBLETON. London :

J. and A. Churchill. 1886.-The answer supplied by theauthor of this brodure to the question stated in its title isa simple one. He rejects one after another all previouslyaccepted theories upon the nature of phthisis, from thebacillus backwards, and arrives at the conclusion that theessential underlying cause is diminished pulmonary capacityinduced by artificial modes of life, sedentary occupations,

tight clothing, and the like. In his view, then, consumption is not only an acquired disease, but one which by dueattention to the conditions favouring natural physicaldevelopment might be eradicated. The very simplicity ofthe doctrine constitutes its chief attraction, and as thethesis is maintained with commendable brevity our readersmight do worse than make themselves acquainted with itThe author himself is very strongly impressed with thetruth of his doctrine.An Accolmt of a West Indian Sanatorium, and a Guide to,

Barbadoes. By the Rev. J. H. SUTTON MOXLY, Chaplain tothe Forces. Pp. 209. London: Sampson Low and Co. 1886.-This volume was written in anticipation of the Indian andColonial Exhibition, the author being desirous of bringingto notice " the great salubrity of the island, and the benenciateffects on invalids of a brief visit to the place." It appears,to ba a good guide-book to the various places worth visitingin the island, but we have failed to find in it any informa-tion which would justify the recommendation of Barbadoesas a sanatorium, beyond the statement of the author thathe has convinced himself "of the wonderful salubrity of theisland, and of its peculiar fitness, especially during th&winter months and those of spring and early summer, as a.place of resort for invalids suffering from pulmonary orthroat affections, or from general debility." He also asserts.that it is the healthiest station at which British troops are’quartered, a statement which we believe to be quiteincorrect. His own description of the sanitary condition ofthe island is by no means reassuring. "There is no systemof drainage in Barbadoes outside the garrison. Bridgetownitself is undrained; old-fashioned cesspits serving, or beingsupposed to serve, to convey the sewagp, by infiltration, tothe sea." In the country districts matters are still worse,,for the water-supply is derived from wells and from surfacestreams and ponds " whose condition is often loathsome."The author states, however, that active measures are nowbeing taken to ensure an abundant supply of pure waterbeing brought within reach of every household. The stateof the profession in Barbadoes is eminently unsatisfactory.Speaking of the medical practitioners, our author says o" There are many mere charlatans; men who, having spenttheir youth behind the counter of a general store or in

similar employment, have gone to America for a few months,,and, returning with bogus’ degrees, or, those of someunknown college,’ set up as physicians and surgeons, andtrade chiefly upon the simplicity of the lower classes andnegroes." By an Act which was recently passed, a three-years’ course of medical study is required before anyone isallowed to practise, " but the terms of the Act are somewhatlax and indecisive as to what constitutes a course of studyof medicine"; it is, however, a step in the right direction.We regret to observe that the author does not appear to haveappreciated the value of an index to his work.New South Wales and Victoria in 1885. By DOUGLA.S M.

GANE. Pp. 207. London: Sampson Low and Co. 1886.-We cannot say that this volume has added to our knowledgeof the Australian colonies. A chapter on "Australia, andthe Voyage thither, considered in regard to Consumption,"appears to have been written under the impression that it is,by no means unusual " carelessly" to advise invalids in an ad-vanced stage of consumption to take a voyage to Australia inthe hope of regaining health. If this impression were correctthe somewhat sensational description of the risks and dis-comforts of the voyage under such circumstances might do,good; but, as we believe it to be quite erroneous, we canonly regret that the author did not take a little trouble to-ascertain the truth before bringing a charge of ignoranceand carelessness against the profession. The chapter on" Fortune-seekers and their Chances" may be read with ad-

vantage by any young men.who think of emigrating toAustralia with the notion hat fortunes are made there-