413

for sciatica out of the hospital. Mr. Holthouse treated theabscess by a long subcutaneous puncture with a trocar andcanula, drew off a quantity of thin watery pus, and carefullybandaged the thigh.A little boy was then brought in with a similar abscess over

his right buttock, the result of scarlatina. Both hip-jointswere inflamed after this disease, but an abscess formed onlyover the right buttock. It had been punctured on two pre-vious occasions, and as the matter was re-forming it was re-peated on the present, with the evacuation of a serous fluid,thus differing from the pus of the two other punctures. Mr.Holthouse preferred this plan of treating abscesses to injectingtincture of iodine, which he thought must be very painful,although he said he could not speak from experience on thatpoint. The result of this plan of treatment was successful.

REMOVAL OF CANCER OF THE LIP.

THE situation of the disease was at the inner surface of theright angle of the lower lip, which was puckered and red. Atumour the size of a walnut could be distinctly felt on intro-ducing the finger into the mouth; it was extremely hard,seemed isolated, but was not movable. It commenced to growfour years ago, after receiving a blow, in the person of a healthy-looking countryman, sixty years of age. It was in a favourablecondition for removal, as it had not ulcerated, and had notgone on to the painful stage of this disease.On the 9th of April, chloroform was given to the patient, at

the Cancer Hospital, and the growth removed by a V incision,by Mr. Marsden, who brought the surfaces of the wound

together by means of pins and the twisted sutures. This veryrapidly united by adhesion in three days, with scarcely anydeformity whatever, and it is to be hoped the recurrence of thedisease may be remote. The nature of the growth was that sousually presented in this situation-namely, epithelial cancer.

Reviews and Notices of Books.Clinical Lectures on the Principles and Practice of Medicine.

By JOHN HUGHES BENNETT, M.D., F.R.S.E., Professor ofthe Institutes of Medicine and Senior Professor of ClinicalMedicine in the University of Edinburgh, &c. &c. SecondEdition, with 468 illustrations on wood. pp. 951. Edin-burgh : Adam and Charles Black, 1858.

(SECOND NOTICE.)THE fourth section of this admirable series of lectures dis-

cusses the" Diseases of the Nervous System." In it the author

attempts to show that " cerebral softening" may originate insix ways :-

" 1st, from exudation, which is infiltrated amongst the ele-mentary nervous structures; 2nd, from a mechanical breakingup of these structures by hasmorrhagic extravasations, whetherin mass or infiltrated in small isolated points; 3rd, from fattydegeneration of the nerve cells, independent of exudation;4th, from the mere imbibition of serum, which loosens the con-nexion between the nerve tubes and cells; 5th, from mechanicalviolence in exposing the nervous centres: and, 6th, from putre-faction. "-p. 303.

In the views expressed in this section, and afterwards atpage 882, upon "acute hydrocephalus," we cannot say that wequite accord with the author. The observations of Rostan,Durand Fardel, and others, are considered as fully establishingthe possibility of the occurrence of the cure of chronic inflam-matory cerebral softening; but that the anatomical appear-ances, by means of which pathologists have endeavoured todemonstrate the curability of a softening, are not to be dependedupon. (p. 345.) The doctrines of embolismus and thrombosisare regarded as having been pushed rather too far; for

" Although it is certain that solid plugs may block uparteries, and occasion serious results, it is by no means clearthat all the instances of disease which have been cited as proofof this in the living body really depend on arterial obstruction,or that because cerebral haemorrhage and softening or pneu-monia are, as is well known, common sequelæ of diseased heart,that therefore plugs of coagulated fibrine, derived from the

last-named organ, should originate these secondary lesions."-p. 355.The diagnosis of cerebral heamorrhage from other lesions of

the brain is not always easy, from the fact that a chroniccerebritis may come on imperceptibly, and then induce apo-plexy or sudden palsy. Its differentiation from ramollissementis sometimes especially difficult. The analysis of many caseshas led the author to the conclusion-

" That, on the whole, muscular rigidity or contraction is avaluable sign of softening, when present; but as the softeningmay be permanent, whilst the rigidity is only temporary andindicative of the irritating effects of the lesion, the absence ofthe one is no proof of the non-existence of the other. "-p. 377.An affirmative opinion is given of the occasional propriety of

" tapping" in stationary cases of chronic hydrocephalus. Thedoctrine that caries of a spongy bone never heals, and thatwhere it can be reached, the only remedy is excision, is affirmedto be incorrect, the author having seen some remarkable in-stances of caries and distortion of the vertebrae, which, havingproduced perfect paralysis, have yet ultimately recovered. Itis well known that some few cases have been recorded in which

hemiplegia has occurred on the same side as a lesion found inthe brain after death, and which has been supposed to occasionit. These, however, the author is of opinion, do not constituteexceptions to the general law: " it was by no means impro-bable, as paralysis may be induced without leaving any traces,that in these few cases it was caused by unknown changes inthe opposite hemisphere of the brain, and, as is sometimes thecase, that the lesion found in the hemisphere of the paralysedside had produced no effect."—p. 396. ’

We are glad to find a supporter in Dr. Bennett to thosedoctrines which we have several times advocated in this journal,and which have been so ably and practically illustrated by Dr.Peddie, in relation to " delirium tremens," or what we prefercalling, " Alcolaolism." But we cannot tarry, and must passon to Section VI., which treats of " Diseases of the CirculatorySystem." A great deal has been said of late years about thecomplication of " Bright’s disease" with pericarditis. In Dr.

Taylor’s cases, in no less than ten out of thirty-eight instancesdid the union exist. Yet in Edinburgh where the renal affec-tion is very common, Dr. Bennett has never had a case of itcombined with the cardiac disease. Dr. Christison, in his workon Granular Degeneration of the Kidneys, also states that" pericarditis is seldom seen amongst the sequelæ." Our own

opinion is, that instead of the disease of the kidney being thecause of chronic affections of the heart, the former is more oftenan effect of the latter when the two diseases coincide. We mustconfess we do not regard mercury so valueless in the treatment ofcarditis as our author is inclined to. A highly interesting caseof thoracic and abdominal aneurism is related, in which ’’ Val-salva’s method" was put into operation. It is observed

" The treatment of internal aneurisms by the method ofValsalva has for some time been discouraged in this country,on the ground that it gives rise to a general irritability and tosymptoms of a distressing nature, which are often intolerable;whilst, on the other hand, it is seldom attended by a perma-nently good effect. In the case before us, as well as in that Iformerly treated, no unpleasant symptoms could fairly beascribed to the practice, but on the contrary it produced (espe-cially the bleeding) well-marked relief. The question of thepermanency of the good effects is, I admit, in no way supportedby my experience. But another important practical point,-namely, the temporary relief which bleeding causes, withoutarresting the progress of organic maladies,-here meets withan excellent illustration. "—p. 580.

This same case affords also a good example of the poisonouseffects of aconite.

Section VII. includes "Diseases of the Respiratory Organs."In it the author shows himself to be quite a convert to the"probang" doctrines of Dr. Horace Green, believing not onlythat the larynx may be traversed, but that the bronchia maybe injected. We wish we could coincide in the author’s state-ment. that no remedy seems so good as a full dose of mornhia.