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medial means, though much inconvenienced by the swellingand pain.The patient ivent now, as the distress was very great, to a

surgeon, who leeched and blistered the joint; this did notrelieve her, and incomplete anchylosis became established;some motion remained in the limb, flexion and extensionbeing, however, accompanied with much pain.

Six months after this, the girl applied to another surgeon,who cupped the joint; and, lastly, as the knee was forciblyand permanently flexed, the patient was made to wear steelrods and circular fastenings, with a screw at the back, so as topromote gradual extension of the limb. She would haveimproved under this treatment had she worn the apparatuslong enough, but it gave her so much pain that after sevenmonths she left it off, and the joint was as contracted as ever.The patient then applied to Mr. Hancock, who considered

that the articulation might be forcibly extended under theinfluence of chloroform. The knee was very much swollen,and there was still a great deal of pain in the joint. The

operation took place on the 16th of January; the limb wasforcibly extended whilst the patient was insensible withchloroform, and it was immediately placed upon a splint andfirmly secured to it by a roller.There was much pain in the joint for the first four days;

this, however, decreased gradually, as well as the size of theswelling. The limb is now quite straight, the patella lies veryhigh over the condyles, and the knee is still painful. The

general health is good, and the patient never had any otherillness in her life.Mr. Avery has also treated cases of this kind with great

success; in one of them, a boy about ten years old, the painpersisted, however, a long time.

It appears, from the foregoing statements, that this isa genuine case of what used to be called white swelling. Itmay, without much straining, be surmised, that had the girlapplied for relief earlier, she would have recovered the use ofher limb, by means of leeches, blistering, &c.; and this is an

encouragement to use antiphlogistic means largely when wesee such a case early. ____

ST. THOMAS’S HOSPITAL.

Excision from the Inguinal Canal of an imperfectly descendedTesticle.

(Under the care of Mr. SOLLY.)WE reported some time ago a case of hernia treated at the

London Hospital, (THE LANCET, vol. ii. 1852, p. 241,) in whichthe testicle lay with displaced intestine in the inguinal canal.The hernia had become strangulated, and had been reducedwithout operation; and as the testicle in its abnormal situationgave the patient no pain, and produced no inconvenience, itwas allowed to continue in the groin. The same practice wasfollowed at St. Bartholomew’s Hospital in a case of a similarnature, but in which the strangulation was relieved by theknife, (THE LANCET, vol. ii. 1852, p. 2341.) A case of an ana-logous kind has lately come under Mr. Solly’s care at St.Thomas’s Hospital, with this important difference, that thepresence of the testicle in the inguinal canal was the sourceof great pain and distress to the patient, and that the herniawas not strangulated. In fact, the hernia forms a verysecondary feature in the case, and the question was principallywhich were the best means of affording relief to the patientfrom the constant pain he was experiencing in the unde-scended organ.A case of an almost similar kind has been published by

Mr. Hamilton in the Dublin Journal qf Medical Science,(during the year 1852,) and the same practice was followed bythe Irish surgeon as that which was adopted by Mr. Solly. Theprincipal features of the latter case are as follows:-

Charles T-, aged nineteen, following the occupation ofporter, was admitted into George’s ward, Dec. 7, 1852. Thepatient states that he had, when a boy at school, noticed theimperfection on the left side of the scrotum. Nine yearsbefore the present period he felt, on making a jump, some-thing come down in the left groin, and he noticed in thatlocality a tumour of the size of a nut. No pain was expe-rienced at the time; but two years previous to admission, thepatient experienced, while carrying a load on his head, asudden and very sharp pain running down to the groin, andthis pain has been annoying him more or less ever since. Thedistress was at first so great that the patient applied at Guy’sHospital. In this institution soothing applications were usedat first, and endeavours were made, while the boy was insen-sible with chloroform, to guide the testicle into the scrotumBut this plan did not succeed; a sand-bag and bandage we

subsequently used, but he was eventually given a liollowtruss. The pain had continued all the time he was undertreatment-viz. three months.The boy applied afterwards at other hospitals, but as there

was no strangulation of the intestine which lay by the side ofthe testicle, interference for the mere pain was declined.

I At this time the protruded intestine and the testicle wouldform, when the patient stood up, a tumour about the size of aduck’s egg. The pain in the swelling did not abate for two

years, as we stated above; and after having been an out-patient at this hospital for some time, the boy was admittedunder the care of Mr. Solly.Leeches were at first applied; the abstraction of blood gave

a little ease, but as the pain soon reappeared as severe asbefore, Mr. Solly resolved to perform an exploratory ope-ration ; and on January 8,1853, an incision was made overthe tumour. The testicle was found in the canal with someintestine; the latter was returned into the abdomen, and itwas agreed that the best course to be pursued was to removethe testicle altogether. The cord was accordingly divided,two arteries tied, and the testis taken away. It was small insize, healthy in structure, but did not contain the usual secre-tion. The wound was brought together in the usual way, andthe patient put to bed.He progressed very favourably for the first few days, but

had then a slight attack of peritonitis, which was relieved bycalomel and opium, and a blister over the left portion ofthe abdomen. Leeches could not be thought of, as the patientwas very weak and blanched. This attack was effectuallysubdued, and the boy is now in a good condition; thewound discharges healthy pus, and there is every likelihoodof his doing well. We may add, that last Saturday, January22, 1853, Mr. Bowman also removed a healthy testicle at

King’s College Hospital; but the organ was in this case

buried in a thickened tunica vaginalis, the cavity of whichwas filled with blood and serum. We shall give next weeka few details of Mr. Bowman’s case.As to the cause of the pain in Mr. Solly’s patient, it might be

owing to stretching of the cord, pressure of the walls of thecanal upon the testicle itself, or of nervous origin. It is, how-ever, rather strange that this boy, and the patient treated inDublin, should have experienced such constant distress, whilstothers with the same malformation are hardly aware of the

imperfection. _- __ __._.. -__-

Reviews and Notices of Books.

A Treatise on Auscultation and Percussion. By Dr. JOSEPHSKODA. Translated from the Fourth Edition, by W. O.MARKHAM, M.D., Assistant-Physician to St. Mary’sHospital. pp. 346. London: Highley and Son. 1853.

PROFESSOR SKODA, for many years one of the chief teachers of,and an authority in regard to, percussion and auscultation inGermany, possesses the merit of having brought the powers ofa very independent and reflective mind to bear upon the phe-nomena of disease presented to his inquiry in one of the mostextensive hospitals in the world. He nowhere appears to act

upon foregone conclusions, but investigates quietly, patiently,and perseveringly; the results that he has arrived at, both byexperiment and by observation, are laid down in the book ofwhich we have given the English title above; and the esteemin which the work is held by his countrymen, is best shownin the circumstance of four editions having already beenrequired. The English reader will not find himself repelledby any mysticism or ideology, but will at least be constrainedto admit the thoroughly practical character of the treatise,both in regard to the Professor’s method of arriving at a con.clusion, and in respect of the manner in which he tests andapplies his doctrines at the bedside. A fault that we oftenmeet with in works devoted to a spécialité—an over-refine-ment of distinctions and divisions not existing in nature, orrecognisable by an unbiassed miiid-is one that frequentlyrepels the student, or induces him to put aside the study of

the subject as unprofitable. Skoda cannot be chargeablewith committing this error; he does not ride his hobby, as theFrench and some of our English writers have done, too hard;and while he makes no attempt to establish classificationswhich may not be verified at the bed-side, he does not claim

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for auscultation and percussion more than may be legitimatelyattributed to them as means of physical diagnosis. The

failure of even practised stethoscopists in detecting, or ratherdetermining the nature of, lesions, is a frequent occurrence,and ought to be a warning to the physician not to contemnthe old Hippocratic symptomatology of disease. But it is

gratifying to hear a master of the art of searching the hiddensecrets of the human thorax, while he zealously tries to

explain what we may discover, also tell us distinctly, thatthe Protean forms of disease are not all to be measured by onephysical rule. Skoda concludes, and we think very justly, that

″ Percussion and auscultation offer very few certain signsof the presence of a cavity ; experience teaches us thattubercular masses and tubercular infiltrations do not existfor any length of time without producing cavities ; we

may therefore safely suppose their presence wherever thetubercular disease is of some standing. Loud bronchialbreathing, loud, large, bubbling rales, and bronchophony, arefrequently heard over cavities; but we as often, and oftenerindeed, meet with cavities which do not reveal themselves toos by auscultatory signs."The work is divided into two parts: the first contains a

description of the phenomena observable by the aid of auscul-tation and percussion; the various sounds elicited by percus-sion are described and classified, and the author gives forthseveral explanations which are both striking and ingenious.It is probable that some of his views will excite discussion,but he advances nothing rashly or unadvisedly. He advertsto the information obtained by the resistance offered by thepercussed surface, and then passes to the consideration ofauscultation. The organs of respiration are first examined.It is here that we find an exposition of the author’s views ofconsonance, as the law regulating the irnpressions we receiveof the patient’s voice, in opposition to the commonly-receivedtheory of conduction. Skoda here, as elsewhere throughoutthe work, duly examines the doctrines taught by the mosteminent writers on the subject. Occasionally a polemicalspirit is evinced, which carries the author a little out of thecalm track of literary inquiry, but generally he expresses hisviews, where they differ from those of other inquirers, in adignified manner.The exposition of the auscultatory phenomena presented by

the organs of circulation, concludes the first part of the work.In the second part we find the symptoms of individual dis-

eases, as determined by auscultation and percussion, detailedand analyzed. The thoracic and abdominal organs are passedin review in their healthy and morbid conditions; and it ishere more particularly that we learn to appreciate Skoda’sfreedom from prejudice, as well as his tact as a professor ofauscultation and percussion.

It is impossible, within our limits, to enter fully into thedoctrines of a w riter like Skoda; we must content ourselves withdrawing the attention of the profession to his appearance in anEnglish dress; and we do not doubt that the great reputation ofthe author, which has already found an echo in England, willcause him to be well received. Dr. Markham has done allthat is to be expected of a translator; the version is not onlycorrect but elegant, and is not defaced, like the original, bythe constant introduction of italicized passages, which seemto forestall the reader’s judgment, and are certainly a greatinterruption to continuous reading. Those who may take thetrouble to compare the original with the translation, will de-tect some further differences which contribute to enhance the

English edition: Dr. Markham has in many instances intro-duced the author’s notes into the text, which will thusavoid diverting the reader’s attention, as they do in theoriginal. The translator’s preface has the advantage of beingwritten with some warmth, which shows that the labour hasbeen one of love, and not a mere task; we have therefore nohesitation in prophesying that Dr. Markham will earn thethanks of the profession for having introduced to them Pro-fessor Joseph Skoda, of Vienna.

THE EXAMINATION IN MIDWIFERY AT THECOLLEGE OF SURGEONS.

To the Editor of THE LANCET.SiR,—On perusing your editorial comments upon the new

Examination of the College of Surgeons for the Licentiates ofMidwifery, and especially on the clause by which individuals areallowed to present themselves for such examination without

previously becoming members of the College, I was struck bythe apparent justice of some of the remarks; but on looking overthe names of those who compose the Council, men who deservedlyare generally and highly esteemed by the profession, I felt as-sured that they must have had some good and sufficient reasonfor such a proceeding, and I have therefore collected all theinformation which lay in my power, and as far as I can learn thefollowing are the facts:-The clause in question had been much discussed on various

occasions, and strongly objected to by various parties; but a legalopinion had been taken, and it had been declared, that by theunintentional wording of the Act, there existed an obligation toadmit any person who chose to present himself for examination.The only method of obviating this difficulty was thought to bethe one adopted-viz., by requiring certificates of attendance onlectures and hospital practice not very far short of the Collegecurriculum, and by raising the fee to a much higher amount thanthat required of a member, so that there could be no great in-ducement for any individual to stop short in his studies, whenso near to the full complement, and to pay eight guineasextra for what assuredly by itself would be a lower position inthe profession. I have learned also that it is very likely a newcase will be presented to counsel, and if the former opinion benot confirmed, that the College authorities would be equallyanxious with the members to get rid of the obnoxious clause, orto modify it considerably. In days when it is so difficult to adjustthe clashing interests ot different examining bodies, the step takenby the College of Surgeons in at length recognising the impor-tance of obstetric knowledge, certainly deserves much credit, andwe should evince all due consideration for the resolution theyhave shown in carrying it out. Few subjects of legislation arefound perfect at first, and it would perhaps be better to wait forgradual amendments at the hands of those who are attempting tofulfil our own wishes, than by any unjust aspersions on theirmotives to frustrate the good they intend, and perhaps thus obligethem to retract what they have already given to us. A s to com-bining the obstetric with the surgical examination, many difficultiesare met with. Two perhaps will suffice. The Council is com-posed of pure surgeons, who do not profess to have sufficientacquaintance with the subject; and those who intend to practicesurgery alone, might justly object to be examined on these points.I cannot close these remarks without adverting to the virulent re-marks of another journal on the subject; the ,. clashing interests"which I have alluded to will offer a sufficient explanation of them.

I am Sir, yours respectfully,OBSTETRICUS.

’*** The position and character of our correspondent give hisremarks importance upon this question. If the Council be ham-

pered by the wording of the act, we would suggest to them toput another question to counsel-viz , how to proceed to amendthe act ? This would be far better than awkward efforts to evade

it.—ED.L.PRIZES AWARDED BY THE ACADEMY OP SCIENCES

OF PARIS. -These very important encouragements to thelabourers in the field of medical science, were awarded at themeeting of the 20th of December, 1852. Among the authorswho were rewarded, we notice-Dr. Budge’(an English physi-cian) and Dr. Waller, of Bonn, for physiological researches;M. Lebert, for his work on cancer, and the curable affectionsconfounded with cancer; M. Davaine, for his memoir on theparalysis of the seventh pair of nerves on both sides; and onthe influence of the facial nerves upon the movements of thesoft palate, the pharynx, and the tongue; M. Bretonneau, forhaving introduced the operation of tracheotomy in croup;and M. Trousseau, for having improved and simplified thesame operation. M. Niepce also obtained a prize for hisresearches on cretinism; and M. Renault, professor at theVeterinary School of Alfort, had a prize allotted to him forhis investigations, both practical and experimental, on theeffect produced by the ingestion of virulent matter into thedigestive canal of man, or the domestic animals. M. Renaulthas found that virulent fluids have no influence on the intes-tinal tract of domestic animals, and that their flesh does not,by such ingestion, become unwholesome.