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the leg diminishing; the temperature of both the limbs is nowabout the same.

Sept. 1st.—Can now get up and walk about a little; nopulsation can be detected in the tumour; popliteal space muchmore defined; pressure removed.

29th.--Greatly improved; has no pain; the swelling is muchdiminished; can walk well now.

Oct. 15th.-The circumference of both the limbs the same;a little hardness remains in the popliteal space; has no pain.Cured.This man remained perfectly well in the autumn of 1850.Remarks.—This case affords a striking contrast to the pre-

ceding one, and presents us with a very favourable specimenof the pressure treatment. The patient, seven years youngerthan the subject of the first case, was of sound constitution andtemperate habits. The case was so far complete at the end ofthree weeks, that the pressure was then safely removed, andthe patient might have left the hospital a month earlier thanhe did, had it not been thought right to detain him for a time,with the view of watching the diminution of the sac. Thecure of the disease was here effected as rapidly, with as littlepain and certainty, and with less danger, than if the operationof tying the artery had been performed.

Reviews and Notices of Books.An Inquiry into the Pathological Irnportance of Ulceration of

the Os Uteri. Being the Croonian Lectures for the year1854. By CHARLES WEST, M.D., F.R.C.P., Physician-Accoucheur to St. Bartholomew’s Hospital, and Physicianto the Hospital for Sick Children. London : Longman andCo. pp. 95.

DISCUSSIONS touching the pathology and treatment of uterinediseases have been marked, in medical societies, with a warmthand even a violence somewhat discreditable to those who so far

forget what is due both to our profession and the arena inwhich they spoke; and so often has that impetuosity comebefore the medical public, that the boisterousness of uterinedebates has become quite proverbial. It may then easily beimagined that, when we read the title of the book before us,and when we perceived that it professes to treat of the verysubject which has for some time past been the bone of conten-tion amongst obstetricians, we suspected that our task wouldbe far from an agreeable one. In this expectation we werethoroughly disappointed; for Dr. West’s Croonian Lectures area perfect model of temperate, courteous, and well-bred criti-cism.But the Lectures have the additional merit, besides being

couched in a language fully becoming the audience beforewhom they were delivered, of being replete with facts andarguments of a most satisfactory character. As to the dueconsideration paid by Dr. West to the good faith of his oppo-nents, we would just make a few quotations:-

" In doing this, (to discuss the opinions of those who over-estimate the pathological importance of the ulceration of the osuteri,) I must crave your indulgence, and that of all personsfrom whom I may differ; for I am fully sensible how often Imay need for myself that candid interpretation of my state-ments, and that lenient judgment of my errors, which I hopealways to manifest to others. "-p. 17.

" The annals of medicine are full of instances of the extentto which pre-conceived ideas modify the experience of menwhose honesty is as much above suspicion as their ability isbeyond question; and no fellow of this College will doubt theintegrity or the talent of either of the would-be combatantswho, some hundred and twenty years ago, drew their swordsin Cheap side to settle the proper treatment of small-pox."-p. 86.I I proposed to mvself only to inquire into the patholo

gical importance of ulceration of the os uteri.’ In doing this.I have had of necessity to refer to opinions from whichdiffered. It was no want of respect for many of those wh(entertain those opinions, and whose talents have done so mudto render them (the opinions) popular, which has led m.t

studiously to abstain from referring to them by name; but =believe, and I have high authority for acting on the belief

that the cause of truth gains much by a course which notonly avoids personal controversy, but confines attention to thereal merits of the case, independently of extraneous circum-stances which ought not to influence the decision.’ "-p. 94.Having said thus much respecting the manner in which Dr.

West carries on his criticism, let us see upon which particularuterine subject it bears. We may give it in the author’s ownwords :-

" The really important question is, whether ulceration ofthe os uteri is to be regarded as the first in a train of processes,.which are the direct or indirect occasion of by far the greaternumber of the ailments of the generative system; or whether,on the other hand, it is to be considered as a condition of slightpathological importance, and of small semiological value-acasual concomitant, perhaps, of many disorders of the womb,but of itself giving rise to few symptoms, and rarely callingfor special treatment ?"-p. 14.In approaching this question," says Dr. West, " little

further, as we are bound to do with no conscious bias of themind in one or the other direction, three different possibilitiesat once suggest themselves to us, of which any one may becorrect.-" 1st. Ulceration of the os uteri may be the cause of all the

symptoms of uterine disease which have been attributed to it;and consequently it may be of no less importance to remove itwhen present, than to ascertain the fact of its existence.2nd. Though not of itself the cause of the symptoms, or atleast of the greater part of them, it may yet be the concomitantof certain forms of uterine disease, of the state and progress ofwhich its extent and degree may be a trustworthy index. Inthis case, though of small importance, as far as therapeuticalproceedings are concerned, it may yet be of great semeiologicalvalue. 3rd. Neither the one nor the other of these suppo-sitions may be correct; but either the ulceration may existalone, giving rise in that case to few symptoms, or to none atall; or it may, in other instances, complicate different uterineailments, though not an index of their state, nor varying withtheir changes. "-p. 40.The author considers that the two first possibilities should be-

rejected, and endeavours to prove, by facts and analogies, thatthe third should be the guide of practice. He calls’to his aidthe anatomy and physiology of the uterus, the post-mortemappearances of the organ, the phenomena of ulceration of theos in procident uterus, and the results of clinical observation.It is principally, however, upon the latter basis that Dr. Westgrounds his opposition to the doctrine he is combating ; and hefreely confesses that the evidence resting on the anatomy andphysiology of the uterus, on inspections after death, and on theexamination of the procident womb, is not unanswerable; buthe lays much stress on the facts obtained by clinical observa-tion, which are most carefully arranged in eleven differenttables. And here we beg to congratulate Dr. West on the usehe is making of his hospital opportunities, for we find that hisinvestigations are based upon the records of 1226 cases whichhave been under his care, both at the Middlesex and St.Bartholomew’s Hospitals. We some time back freely expressedour opinion respecting the sluggishness of some of our hospitalphysicians and surgeons in a leading article of this journal, butshall always be happy to give the due meed of praise to thosewho make their nosocomial practice subserve scientific pur-poses.The purport of the tables to which we have alluded is to

ascertain4 ’ whether sterility is more frequent, whether the rate offecundity is lower, and whether abortion occurs oftener, in theone class of cases than in the other (ulcerated or non-ulceratedos uteri); whether menstrual disorder is more common, moresevere, or different in kind; whether leucorrboea is more

abundant, or furnished from a difiereiit source; or whether

pain is less tolerable when the os uteri is ulcerated than whenthis condition is absent. And, lastly, whether similar or

different causes produce the uterine affections in the twoclasses of cases; whether the duration of illness is the same;whether the structural alterations of the womb are alike or

diverse."-p. 41.We refer our readers to these tables and to the remarks

which accompany them. By examining both the former and

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the latter, they will be enabled to judge fpr themselves whichway the great question should be decided. We confess thatDr. West’s facts and arguments have made a deep impressionon our mind, and we suspect that many of those who readthis book will feel inclined to side with the Croonian Lec-

turer ; the more so as the author is not blind to the real

importance of the much-discussed ulceration. We find him

stating, page 80:—

"But it may naturally be asked, whether I then believethat the condition of so-called uleeration of the os uteri is oneof absolutely no importance, adding nothing to a patient’ssufferings, in no respect protracting her illness, calling for notreatment ? I do not believe this, though at the same timedisease of the os uteri is so almost invariably associated withother evident ailments of the organ as to render it very difficultto distinguish accurately one set of symptoms from the other."

The statistical data are mostly contained in the second

lecture; the scope of the third is principally to show that thecauses of uterine ailments are very various, and sometimesindependent of local disease, as in the case of chlorosis, hepaticdisorder, granular disease of the kidney, or the gouty andrheumatic diathesis; the ulceration of the os uteri, when pre-sent in such cases, being of secondary importance.

Dr. West gives reasons for believing that the body of theuterus is in many cases the original seat of the mischief ininflammation of the organ. He adduces some cases, and says :-

" In all of these instances it is, I believe, the interior of theuterine cavity which suffers first; it is thence that the hæmor-rhages are derived-thence that the greater part of theleucorrhoeal discharge is furnished; and it is the irritation ofthat part of the organ in which its most important functionsare transacted which leads to the increase of its size, so apparentin the great proportion of cases of long-continued uterine ail-ment. That the ovaries suffer too, constant observation proves,and facts illustrative of the affection of the neck of the wombare also perpetually coming under our notice; but that, as ageneral rule, inflammation of the canal of the cervix is the firststep in the disease, and ulceration of the os uteri the second,and that these two conditions are the two factors, producingall the symptoms we have been studying, is an assumptionwhich I cannot but regard as unsupported by facts, and asopposed to any fair inference from what anatomy, physiology,or analogical reasoning, teach us. "’-p. 77.

But it might well be urged against opinions like these,that the practice of those who differ iii toto from Dr. West hasbeen very successful; that the results have been extremelysatisfactory; and that cures have been effected where the patientshad long sought for relief in vain. These facts are interpretedby the author of the book before us in the following manner:

"It may, however, be asked,-How is it that successfulresults have followed a course of treatment directed exclusivelyto the cure of ulceration,-that the application of caustics to theos uteri has been succeeded by the restoration of the patient tchealth? Now, I think it should be borne in mind, that in con-nexion with this mode of treatment, various other measures areof necessity adopted, eminently calculated to relieve many ojthe slighter forms of uterine aliment. The married woman isfor a time taken from her husband’s bed; the severe exertionto which either a sense of duty urged, or a love of pleasureprompted her, is discontinued, while rest in the recumbentposture places the uterus and the pelvic viscera in just thaiposition in which the return of blood from them encounters thEsmallest difficulties. The condition of the bowels, probablebefore habitually neglected, is now carefully regulated, and thEpatient’s diet, bland, nutritious, and unstimulating, often differ:widely from that which, while all her functions were overtaxed,she vainly strove to tempt her failing appetite. Add to this.that the occurrence of the menstrual period is carefully watchecfor; that all precautions are then redoubled, and each symptonof disorder, such as on former occasions had been borne uncomplainingly, though often not without much suffering, is now alonce encountered by its appropriate remedy; while, generally.returning convalescence is met in the higher classes of societJby a quiet visit to the country, or to some watering place, irpursuit, not of gaiety, but of health; and we have assemblecjust those conditions best fitted to remove three out of four o

the disorders to which the sexual system of woman is subject."- pp. 84, 85.Having thus sketched the purport of these Lectures, mostly

in the author’s own words, and shown that he has made outa very strong case, we may perhaps just mention that Dr.West, in fixing his attention upon the body of the uterus,has probably undervalued the share which the follicular appa-ratus of the neck has in the morbid phenomena connected withuterine disease. The author also doubts the existence of thecervical secretion, which Dr. Tyler Smith describes in his excel-lent paper on the "Pathology and Treatment of Leucorrhœa,based upon the Llicroscopical Anatomy of the Os and CervixUteri." ("Medico-Chirurgical Transactions," vol. xxxv.) lluchcaution is, however, necessary in dealing with these matters, asfacts, observed by careful investigators, should not be lightlyrejected. Dr. Tyler Smith proves that the crypts, follicles,&c. &c., of the mucous membrane of the cervix are very activein leucorrhcea; but he is fully sensible, like Dr. West, of theimportance of the apparatus in parturition; for we find him stateat page 7 of his Memoir:-" Probably it is owing to the greatextent of the reduplication of the mucous membrane of thecervix that laceration of the mucous surface does not more

frequently occur during parturition."Dr. West alludes to Dr. Tyler Smith’s researches at page 2T

of the Lectures; but it is probably owing to an oversight, mis-apprehension, or misprint that reference is made to the laboursof " Drs. IIassall and Tyler Smith." " In general, when a memoiris alluded to, the author’s name is given first when any ofthose friends who have assisted him may also be mentioned.Dr. Tyler Smith is under obligation, as he states at page 2

of his Memoir, not only to Dr. Hassall, whose reputation is

in no need of any accidental assistance, but also, in a lesserdegree, to Dr. Handfield Jones, and others. This incorrect-

ness is but trifling, but we just allude to it as we stronglyuphold the palmam qui meruit ferat.

In conclusion, we cannot but express our high estimation ofthese Lectures, which have thrown a strong light on warmlycontroverted points of doctrine and practice, and we congra-tulate the author on the temperate and becoming language inwhich he has clothed his critical remarks.

Food and its Adulterations; comprising the Reports of theAnalytical Sanitary Commission of THF LANCET for the years1851 to 1854 inclusive. Revised and extended, &c. ByARTHUR HILL HASSALL, M.D., Chief Analyst of the Commission, &c. &c. Illustrated by 159 Engravings. pp. 659.London : Longman, Brown, Green, and Longmans.

IT will naturally be expected that we should speak with somepartiality of a work, in the production of which we ourselveshave borne a considerable share. But deeply impressed as weare with the immense importance to the public health of theresearches, the results of which are brought together in thebook before us, we feel at the same time that we are relievedfrom the task of entering at any length into a description of itsobject and contents, which are widely known to the scientificand commercial world, or of praising that which has alreadyreceived the meed of universal approbation.

It is, however, but a tribute of justice to the extraordinaryscientific merit and energy of the author, that we, leaving toothers, as we may now fairly do, on the occasion of the separatepublication of these admirable reports, to comment upon thepart we have borne in this production, should express ouropinion of the general merits of the work.ii The public importance of the work may be to some extentestimated by reflecting upon the two following circumstances:

1. No one doubts that one of the chief conditions of health isthe injestion of pure and wholesome food. Previously to thecommencement of these Reports in THE LANCET, in 1850, it wasundoubtedly a matter of notoriety, that the prime alimentaryarticles were generally and scandalously adulterated. But

nothing was known with the precision necessary to suppress the

98

wide-spread fraud, or to enable the consumer to avoid purchasingspurious and injurious commodities. So impracticable, indeed,was it held to apply more effectually the unlimited resources ofscience to the detection of adulterations in food, that in thecase of coffee, which formed the subject of the first Report, SirCharles Wood, late Chancellor of the Exchequer, did not hesi-tate to quote in the House of Commons, as the deliberate

opinion of those of the most distinguished chemists of the day,the assertion that neither by chemistry nor by any other meanscould the admixture of chicory with coffee be detected! It isnow unnecessary to say how completely Dr. Hassall dispelledthis delusion as to the circumscription of science, and how hedemonstrated that the microscope, wielded by the skilful natu-ralist and chemist, was able to unravel and to analyse thecomponent structures of substances that bid defiance to theblowpipe and the test-tube alone. It is the great and originalmerit of Dr. Hassall to have applied the microscope to impor-tant uses in inquiries of this nature, and to have shown by itsuses not only many things previously considered impossible toshow, but many things not previously suspected to exist.The adulterating rogue had fondly imagined that by infini-tesimal division, artful mixing, and various other mechanicalprocesses, he could baffle the severest scrutiny into the com-position of his " pure" and " genuine" wares. The chemisthe had, indeed, baffled. All organic structures may be re-solved into a small number of ultimate constituents ; it is often

impossible to discriminate the higher or proximate compounds. I,Animal and vegetable substances, the most diverse in their ’,characters and properties, under many circumstances, willyield to the chemist precisely similar results. On the other

hand, Dr. Hassall has shown, by an immense accumulation offacts, that it is almost impossible, by any process available incommerce, so to alter the characteristic integral physical formsof organic tissues, as to prevent their being readily recognisedby the microscope. Each vegetable, nay, the minutest partof the structure of each vegetable, has impressed upon it

by nature features and marks as definite and intelligible tothe practised eye of the microscopical observer, as those

grosser features by which we discriminate the different indi-viduals of our acquaintance.

Dr. Hassall, then, has, by methods hitherto comparativelyunpractised, succeeded in the task of unfolding the mysteriesof adulteration. He has enabled every one to avoid thatwhich is prejudicial to health, and to obtain that which is pureand beneficial.The second fact to which we would refer, is this-a large

proportion of the public revenue is still drawn from duties uponarticles of food; and, both for the purpose of protecting therevenue from fraud, and for that of protecting the public frominjury and robbery, the Legislature has instituted a giganticand expensive machinery in order to detect and check thepractice of adulteration. Now, if we take one instance only asan illustration, that, previous to 1850, the Excise regarded thedetection of the adulteration of coffee by means of chicory asimpossible, we shall have a faint idea of the extent to whichthe revenue was plundered in that article alone. The Legis-lature is now, through the labours of Dr. Hassall, put in pos-session of the sure and inexpensive means of effecting the mostimportant savings.To have accomplished two objects of such magnitude, and

of such universal interest, is, it must be admitted, no slightclaim to praise. That Dr. Hassall’s book will have a largeand rapid sale we have no doubt. It forms a handsome

volume, profusely illustrated with microscopical figures, exe-

cuted with that beauty and faithfulness for which his draw-ings are so well known in the profession. It will be esteemed

by the scientific man on account of the many important originalcontributions it contains to vegetable anatomy and physiology.The physician will esteem it for the extent and accuracy of

the dietetic and medical information it conveys. To every

member of the community it has numerous points of interest.The statesman will find in it the basis for an effective refor-mation of the machinery for protecting the revenue fromfraud, and for guarding the public health. Indeed the lastand most conclusive evidence of the importance of the reve-lations contained in Dr. Hassall’s book, is the fact that exten-sive reforms in the laws relating to food, directly flowing fromhis researches, are already agitated in Parliament.

Medical Anatomy. By FRANCIS Smsorr, M.D., F.R.S., Physi-cian to St. Mary’s Hospital. London: John Churchill.Folio. Fasciculus I.DR. SiBSON’s work will fill up a void long felt in medical

literature. The author has well commenced his important task.This part contains plates and descriptive commentaries on the

sternum, ribs, and cartilages, the anterior surface of the lungs,the superficial cardiac region, and the structures of the neck and

diaphragm, in health and disease. The anatomical correctness

and artistical skill displayed in the execution of the plates,and the large amount of valuable information contained in theletter-press, must ensure the success of the work. The produc-tion throughout has evidently had the utmost care bestowedupon it in its preparation; and from the long and well-knownresearches of Dr. Sibson in regional anatomy, its perfect accu-racy, both anatomical and pathological, may be dependedupon. The work will form a new alliance between anatomyand medicine.

Surgical Anatomy. By JOSEPH MACLISE, F.R.C.S. SecondEdition. Fasciculus VII. London: John Churchill.

THIS part contains the following plates, &c. :-An illustrationof the action of thoracico-abdominal apparatus, as affecting themotions of the contained viscera; the surgical dissection of thesuperficial and deep structures of the inguino-femoral region.It fully maintains the high character, and the same skill inexecution, as the preceding parts.

foreign Department.LEAD COLIC TREATED BY THE EXTERNAL AND INTERNAL USE

OF CHLOROFORM.

M. ARAN, physician to the Hospital St. Antoine, in Paris,has just published, in L’ Union Médicale, cases of lead colic, inwhich he obtained excellent results by the use of chloroformadministered internally and applied externally over the ab-domen. In one of the cases the patient was a house-painter,thirty-one years of age, who had had, in the space of twentyyears’ active employment in his business, only one attack ofcolic. In the present instance there was obstinate constipationand vomiting, with very severe abdominal pain, and very slowpulse. To allay the former, a compress, on which about adrachm of chloroform had been poured, was placed on theabdomen. This gave great relief, and M. Aran prescribed,besides a sulphureous bath, a mixture with thirty drops ofchloroform, and a common enema, to be followed by one withtwenty drops of chloroform. This treatment was continuedfor about a week, and had the effect of modifying the symp-toms considerably; but as the effects of the chloroform werevery transitory, it was found necessary to make the patienttake the medicine both day and night. A few sulphureousand some vapour baths were added to the treatment, and six-teen days after admission the patient was discharged in a verysatisfactory condition.A circumstance, which might have given the case a fatal

issue, is worthy of being noted. The patient took, by mistake,a whole ounce of chloroform, which caused very severe symp-toms, from which, however, he recovered.The second case refers to a house-painter, aged thirty-eight,

who had had the colic when he was sixteen years of age, andsince that period some pain and twitchings in the limbs. On

admission, there was severe bilious vomiting, cramps, pain inthe abdomen, with retraction of the umbilicus, constipation,&c. The treatment was about the same as in the former case,