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Erichsen, avoiding all cutting operations, contented himselfwith simple dilatation, by a two-bladed screw dilator, and thepreviou;3 use of a sponge tent. Seizing the calculus ultimatelyin a well-made pair of curved forceps, Mr. Erichsen abstractedit entire, when it proved of the size of a garden bean, and con-sisted of lithic acid.

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GUY’S HOSPITAL.VARICOSE ULCERS, AND THEIR TREATMENT BY POSITION

OF THE LIMB.

(Under the care of Mr. HILTON.)

AMONGST the excellent every-day practical cases at preseniin this hospital are some varieties of old and troublesomevaricose ulcers of the legs, which, having. gone through theusual routine of the ordinary plans of treatment by rollers,tying veins, &c., without any amendment, had yielded quicklyto a mode of treatment suggested and tried for some time pastby Mr. Hilton. This plan consists of placing the limb perma-nently in a higher position than the body of the patient, andthus preventing the column of venous blood from pressing onthe congested capillaries. The plan seems simple enough,indeed, perhaps too simple for the present exacting age ofpathological novelties; but in three cases recently of very indo-lent ulcer, at this hospital, the steady application of simpledressings, and keeping the limb above the level of the patient’sbody in bed, by ordinary sand-bags, more than realized Mr.Hilton’s expectations, and in a few days effected a perfect cure.Bandages and lace stockings, in these cases, require theutmost nicety, Mr. Hilton observed, as to their application,for if they press unduly on the granulations, as was veryobvious in one of the present cases, they do more harm thangood, constrict the veins and vessels, and thus throw thepatient back for several weeks. If the roller be applied at all,it requires much careful attention, so as not to act as a con-stricting agent at any point-more attention, indeed, thanstudents can conveniently pay to such cases, the roller notalways passing over the ulcer as it ought to do.

WESTMINSTER HOSPITAL.

TREATMENT OF CHRONIC LUMBAR ABSCESS.

(Under the care of Mr. HOLT.)LARGE lumbar abscesses, connected as they generally are

with scrofulous caries of the vertebrae, present little varietyand possess but a small amount of novelty or interest for surgeons habituated to our larger hospitals. Such cases are

particularly adapted to the expectant mode of treatment—toleaving, in fact, a great deal to the surgery of Nature. ThesEabscesses, observed Mr. Holt to his class one day last week, mayform swellings at or above Poupart’s ligament, or take the courseof the spermatic cord, thus simulating hernia; or, again, theymake their way down to the sacro-ischiatic opening, and puzzlethe uninitiated very much. In the case of a boy, who hasbeen some time in the hospital, the appearance of hernia wasrather marked; but by pressing alternately in the region ojthe head of the psoas and other lumbar muscles, and pressingcautiously on the abscess in the groin, which gave an indistinctimpulse on coughing, the tumour could be made to bulge outor disappear according to the nature of the pressure used.Mr. Holt impressed on his class the absolute necessity of notopening such abscesses. He had never known a large psoasabscess opened by the surgeon either with the seton or valve-like opening recommended by Abernethy, in which the patientdid not sink from fatal attacks of irritative fever. The old

explanation used to be that the pyogenic membrane lining theabscess became inflamed all over its surface; but we believe our

modern pathologists have taught that there was no such thingas a pyogenic membrane secreting pus. Surgeons in generalwere quite familiar with large psoas abscesses, even abscessescontaining quarts of matter, with flakes of curdy substance,like that seen in other abscesses usually denominated scrofu-lous. Tubercle in bone was now known to be sometimes metwith, and more frequently in the spongy bones, like those ofthe bodies of the vertebra, which Sir B. Brodie always findsdiseased in psoas abscess. This tubercle, generally of theopaque yellow variety, becoming deposited in the cancelli, in-duces a gradual absorption of the bony septa, leading to theformation of scrofulous abscesses, composed of a mixture of theproducts of iuflammation, imperfect pus, and additional tuber-culous matter. Indeed, so much are the parts destroyed, thatMr. Stanley doubts if ever a process of reparation is set up atall, no more than in a phthisical cavity in a luncr. The ab-

scesses next spread into the surrounding cellular and musculartissues, as in this case, into the psoas and lumbar muscles, theformation of pus going on gradually from month to month.

Mr. Holt also directed the attention of his class to a some-what singular case which lately came under his observation,and presenting rather a difficult point of practice-viz.,whether the abscess should be opened or not. It was the caseof a married lady, lately pregnant, who had ’a psoas abscess ofabout twenty months’ formation, and of an enormous size,at the upper part of the thigh. If the abscess had burst, orhad been opened, there seemed little hope but she would havesunk under the combined effects of the drain on the system,the irritative fever, and the subsequent excitement and shockof labour at the full period. The proper mode of proceedingwould seem rather to be that which he had adopted. She waswell supported, and delivered prematurely of a living child atseven months, and the abscess was treated on the ordinaryplan, according to the indications as they arose, the mere factof the abscess being two years growing still presenting someuncertain hopes of her recovery.

Reviews and Notices of Books.On Local Treatment of the Mucous Membrane of the Throat

for Cough and Bronclaitis. By J. E. RIADORE, M.D.,F. R. C. S., late Lecturer on Surgery to the Hunterian Schoolof Medicine, &c. &c. London, 1855. pp. 99.

WE have received several hints of practical value from theperusal of Dr. Riadore’s little treatise, and would advise anacquaintance with its pages to those who have to deal with

any obstinate cases of throat affection. The value of alum, ofthe nitrate of silver, and of the nitro-muriatic acid, in suchforms of disease, will be found here well illustrated. We can-not say, however, that we should hold up Dr. Riadore’s styleas worthy of imitation. It is one scarcely in keeping withwhat is expected now-a-days in scientific productions. The

following critique on homceopathy is the result of the personalexperience of Dr. Riadore, and for its truth is worthy of ex-tract :-

"I attended for a short time the practice at one of thehomœopathic hospitals, and also the lectures there delivered.I found that for all complaints the number of the numerously-named globules, containing or not containing infinitesimalquantities of the drugs after which they were named, were notmore than from ten to nteen at the utmost. The homoeopathicpractitioners have always in their consulting-rooms very largeboxes full of bottles, labelled with the names of every drugmentioned in their very trashy books, which they exhibit asremedies to their deluded dupes, and so impose upon them themagnitude of their varied means of cure. When, however,they leave home to visit their simple patients, a small box inthe waistcoat pocket suffices for cit2-ative purposes; this eon-tains about a dozen of little labelled bottles, the contents andproperties of which are just as well understood, perhaps, bymany learned and skilled young ladies in their teens, whoamuse themselves with the homoeopathic delusion, as by thehoary and medically-educated practitioner who takes up thisvery strange mode of earning a livelihood after having failedto do so in the honourable course of practice." -p. 38.

A System of Instruction in Qualitative Chemical Analysis. ByDr. G. REMIGIUS FRESENIUS. Fourth Edition. Edited byT. LLOYD BuLL&CjK:, F. C. S. pp. 310. London : Churchill.

THE appearance of this new edition, corresponding with theeighth German edition, is the strongest proof that could begiven of its popularity, and practical utility. To the presentvolume some important additions have been made. The

admirable and simple directions, now first given, for the

analysis of mineral and spring waters, and the detection ofpoisons for forensic purposes, will be found to add greatly tothe value of the work. The translation, on the whole, is ex-cellent. There are not nearly so many Germanisms as are tobe detected in most versions of the kind. With regard to thenomenclature, it may, perhaps, be suggested that 8ulphide andphosphide are anything but an improvement on the 8ulphuret

55

and phosphuret to which most of us still adhere, and are muchmore likely to be confounded with sulphite and phosphite. Nochemist can be, and no physician should be, without a know-ledge of qualitative analysis, and the work before us, in its

present state, may be regarded as a very complete epitome ofthe whole subject.

An Essay to Prove the Contagious Character of MalignantClwlera, with Brief Instruction for its Prevention and Cure.By BERNARD M. BYRNE, MD., Surgeon, U. S. Army.Second Edition. Philadelphia, 1855. pp. 160.

WITHOUT giving our assent to all the detailed opinions ofthe author relative to the contagiousness of cholera maligna,we accord in the general proposition that the disease may be,and not unfrequently is, communicated to a previously healthyindividual through the medium of emanations given off fromthe bodies of those already sick of the disease. That this isthe general or usual way in which the pestilence spreads, how-ever, we are not satisfied, in spite of what is here said relativeto the subject, and the assertion " that myriads of humanlives have been sacrificed by not acting in accordance" withthe views of such ultra-contagionism. The doctrine ive would

teach, however, receives but little support from Dr. Byrne,(p. 113,) whose treatise we can nevertheless recommend to allinterested in this difficult and much-litigated question.

Heller’s Pathological Chemistry of the Urine, with short andeasy Directions for its Examination. To which is appendeda brief Account of some of the other Exc2,etions, and of theBlood and Milk. By LUDWIG DAHL. Translated fromthe Norwegian, by W. D. MOORE, A.B., M.B., &c.

Pamphlet, pp. 100. Dublin. 1855.

WE need not recommend this production to the attention ofour readers, since it contains nothing with which they are notalready familiar. The classical work of the late Dr. GoldingBird, with its European reputation, must still remain the text-book for those who would thoroughly study the pathology andchemistry of Urinary Deposits; while the busy practitioner,with too little leisure for the perusal of monographs, may learnmuch from the brief, but well-condensed summary of the sub-ject in Dr. Tanner’s "Manual of Clinical Medicine," which werecently noticed. It cannot but be regretted, therefore, thatany gentleman should waste his time in translating from theNorwegian a pamphlet which only serves to encumber ourbook-shelves, though, doubtless, admirably adapted to instructthose for whom it was originally written.

On the Influence of Education and Training in PreventingDiseases of the Nervous System. By ROBERT BRUDENELLCARTER, M.R.C.S.E. pp. 438. London: Churchill. 1855.

MR. CARTER, in his preface, puts forward a plea for criticalmercy, on the score of Lis work having been hastily completed,previous to his hurried departure for the Crimea. If we are to

allow this allegation to have any weight-as we are inclined todo-we must say but little of the present production; for sincewe cannot award praise where merit has not been shown, soalso we are unwilling to say aught that can hurt the feelings ofa gentleman, who, we are convinced, must be much betteremployed in alleviating the sufferings of our soldiers beforeSebastopol, than in compiling heavy treatises on the Surreyside of our cloaca magna.

Foreign Department.A NEW METHOD OF USING THE CATHETER, AND INSTANTANEOUS

CURE OF STRICTURES.

M. MAISONNEUVE communicated on the 14th of May, 1855,to the Academy of Sciences of Paris, a memoir, in which hedescribes his method of catheterism, which may briefly besketched as follows :-The author, being struck by the advan-

tages of passing a tube over a conductor in the treatment ofstricture, (as practised by Mr. T. Wakley in this country,) pro-poses, when the stricture is very narrow, to introduce a filiformbougie into the bladder, to screw a metallic instrument to thefree end of it, and to push on that instrument along the canal,making the bougie recede into the bladder, in the cavity ofwhich it is expected to bend upon itself. The instrument usedmay be either of those which have been proposed to dilatestrictures or to cut through them. The author thinks, how-ever, that bad coarctations should be divided from beforebackwards, and he operates in the following manner :-When the bougie has reached the bladder, a grooved urethro-

tome is pushed onwards through as many strictures as thecanal may present, the bougie bending upon itself in thebladder. Along the groove, a rod, furnished with a sharpblade at its extremity, is pushed on, and made to cut theurethral obstacles. When this is done, the grooved urethro-tome is withdrawn, and a second introduced, to the extremityof which a hidden blade is attached. As soon as the instru-ment is fairly in the canal, the blade is protruded by means ofa spring; and on withdrawing this urethrotome cache, thestrictures are again fully divided. The peculiarity of themethod is that the author considers that the freedom of thecanal after these incisions would be prevented by leaving aninstrument on the raw surfaces; he thinks that the part shouldbe allowed to heal without any catheter, and maintains thatthe cure is instantaneous, as the patient is immediately able topass urine in a good stream. The Academy of Sciences haveappointed a committee to report upon this method, M. Civialebeing one of the members.

TREATMENT OF OLD UNUNITED FRACTURE BY THE SUTURE 01

THE FRAGMENTS AFTER OBLIQUE RESECTION.

M. LAUGIER has submitted to the Academy of Sciences o:

Paris a case of ununited fracture of two years’ standing, irwhich he performed the above operation. Before detailing th(case, the author stated that Mr. Kearny Rodgers, in 1825, hadsucceeded in obtaining union by resecting the fragments of th(humerus, and keeping them together by a silver wire; thepatient was fifteen years old, and consolidation was obtainedafter sixty-nine days. Valentine Mott had a similar favourablecase in 1831. M. Flaubert, of Rouen, has also operated uponthe humerus; he brought the fragments together after resectionby means of four waxed threads, and kept the bones in accurate contact, but union did not take place. It is to be noticedthat the fragments were always sawn perpendicularly to theaxis of the shaft. It was M. Flaubert who first remarked thaithe chances of union would perhaps be greater if the boneswere resected obliquely, so as to bring them in contact over alarger surface. M. Laugier observes, with much truth, thaiby sawing obliquely we do not shorten the bone, and rendeIthe operation easier, less protracted, and less dangerous.

It will be recollected that the wire has been used by Mr.Stanley in a case of ununited fracture of the femur; the casewas reported in the "Mirror" of this journal, and necessitatedeventual amputation, (THE LANCET, vol. ii. 1854, p. 81.)M. Laugier’s patient is a man of forty-one; the fracture had

occurred just below the insertion of the deltoid, and the frag-ments had remained separated for almost two inches, the limbbeing quite useless. The seton had failed twice, the scrapingof the ends of the fragments having been superadded at thesecond operation. At last M. Laugier resected both fragmentsobliquely, taking off so much bone as to re-establish the con.tinuity of the cylinder. A perforation was then made througheach fragment, and a ligature, composed of several waxedthreads, was then passed through the orifices, and the boneskept in close approximation.The ligature, which had been allowed to hang out of the

wound, fell at the end of three weeks, and, the loop havingbeen found entire, it was concluded that the thread must haveworked its way through the bones. The arm was then put ina gutta percha apparatus, with a movable valve, to allow thelimb to be examined; the suppuration never was profuse, andthe sympathetic fever trifling. It may be remarked that theoblique section does not of course require the complete andcircular denudation of the bones, which takes place in thehorizontal section.On the forty-second day after the operation consolidation

seemed in a fair way of formation, and M. Laugier thinks thatin about one month the union will be complete. It is to be reogretted that the author did not wait for the completion of thecase before mentioning it at the Academy. We hope, however,that he will give the ultimate results to the professionalworld.