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numerous as to present the appearance of beads strung on athread. The large tumour which was observed during lifebelow Poupart’s ligament was found to be connected with theanterior crural nerve. It was enclosed in a fibrous capsule,and on section presented the appearance of a fibro-cellulartumour interspersed with cysts. These cysts were of varioussizes, the largest being about the size of an egg, and partlyfilled with imperfectly organised blood-clots. A second smalleicyst was filled with gelatinous material. The remaining smallcysts were filled with clear serous fluid.

Reviews and Notices of Books.CCl8es illustNti1Je of the PCltlwlogy of Dysente’y. With Iie7accrl;s.

By Dr. S. G. CHUCKEHBUTTY, Officiating Professor of Cli-nical Medicine, and Second Physician to the Medical Col-lege, Calcutta. Calcutta : Military Orphan Press.Tuis is a valuable contribution to the pathology of Indian

dysentery, as seen in that unsanitary and most unsavory citywhich may be regarded as the head-quarters of this formidabledisease. The little pamphlet consists of a brief abstract offorty-one cases of dysentery observed by the author in thehospital of the Medical College, Calcutta. It appears that in

fourteen months Dr. Chuckerbutty treated 280 cases of dysen-tery. Of these, 189 were discharged, and 91 died; the mor-tality thus being 32’5 per cent. In only 38 of the fatal caseswas a post-mortem examination obtained, and the whole ofthese are given. There is also a careful summary of themorbid anatomy of the cases, showing the lesions resulting(1) from irritation of the mucous tubular glands; (2) from con-gestion of the mucous membrane; (3) from exudative inflam-mation of the mucous coat; (4) from follicular inflammation ofthe mucous coat; (5) from phlegmonous inflammation of themucous coat; (6) from erysipelatous inflammation of the mu-cous membrane; (7) from gangrene; (8) from submucouscellulitis; (9) from tubercular deposit; (10) from "intestinalapoplexy"-an ill-chosen term, by which the author intendsto express effusion of blood in the submucous tissue.

Dr. Chuckerbutty also gives a summary of the lesions re-sulting apparently from " disorders of the blood," as in casescomplicated with albuminuria, syphilis, &c. No less thanfifteen different kinds of sloughs are described, and ten dif-ferent varieties of ulcers.There is also a summary of the complications found in the

cases examined-e. g., liver: (a) simple congestion, 1 case ;

(b) portal congestion, 3 cases; (e) enlargement, 2 cases; (d)capsulitis, 1 case; (e) cirrhosis, 2 cases; (f) fatty degenera-tion, 3 cases; (g) abscess, 3 cases; (h) inflammation and ad-hesions of the gall-bladder, 1 case.The author urges that most of the pathological conditions

he so minutely describes in his paper can be diagnosed duringlife; and hence the value of an intimate acquaintance withthem. " Careful physical examination will supply in dysenteryas certain information as it does in a case of pneumonia orBright’s disease." The modes of physical examination insistedon are : 1st. The examination of the abdomen by careful pal-pation to detect tenderness, thickening, &c., and the con-

dition of the solid organs. "Tenderness and thickening ofthe intestine point to the seat of the inflammation, or, if con-siderable, to the situation of separating sloughs or colicklydistension of the diseased structures." The information thusobtained has, in the opinion of the author, important bear-ings on practice-e. g., " showing, firstly, where leeches andblisters should be applied; secondly, where ice may be ap-plied in cases of hemorrhage." 2nd. The examination ofthe stools. In a foot-note to this part of his paper, Dr.

Chuckerbutty acknowledges that the particular method of in-vestigating the stools described in the text was first practisedand described by Dr. Edward Goodeve, Professor of Medicinein the Calcutta Medical College. This is well, so far as it

goes. But Dr. Goodeve did more than describe the mechanical

process of examining the evacuations in dysentery; he showedthe pathological and practical significance of the various sloughsand other morbid matters, as well as the mode of detectingthem ; and this, we think, our author was bound to acknow-ledge more clearly than he has done in the meagre foot-noteto which we have referred.We have not space to follow Dr. Chuckerbutty into that part

of his paper in which, following Dr. Goodeve, he endeavoursto show the practical information to be deduced from a carefulobservation of the sediment of dysenteric stools when freed bywashing from fascal and other matters. We commend the

paper to the careful perusal of those who hold the opinionthat the lesions of dysentery are uniform in their seat andmodes of commencement and progress; and, in conclusion, wethank Dr. Chuckerbutty for this contribution to pathologicalanatomy, which is creditable to his knowledge and industry,as well as to the school in which he is an efficient and usefulteacher.

Companion to the llleclicine Chest: giving the Proycrties andDoses of the most 11seful D01nc8tic 11Iedicines; also, Direc-tions for 8icl.;-romn Cookeay. By PETER SQUIRE. London:John Churchill and Sons.

i MR. SQUIRE explains the reasons for producing this littlepocket companion to be, that existing treatises having a similarobject are not only too cumbrous, but treat upon many medi-cines that have long ceased to occupy a place in medicinechests of modern construction. The author has therefore, in asmall pamphlet suited to the drawer of a chest, and so alwaysat hand, described the properties of such medicines only asare most serviceable for ordinary domestic use, or for cases ofemergency where medical aid cannot be immediately obtained.The little book is of seductive simplicity, and very handy.But a medicine chest is a possession liable to be much abused;and we fear that this very facile introduction to its "users"

"

is not at all likely to check such abuse. If Mr. Squire couldcompress a manual of diagnosis into as portable and readablea treatise, the good would be unmixed; but the whole subjectof diagnosis and prescription, of which only the latter half ishere attempted, is better left in the hands of the medical prac-titioner, than assumed either by the dispensing chemist or theyet more imperfectly instructed layman, possessed of a medi-cine chest and a pocket companion.

JACKSON’S Gymnastics for the Fingers and 6Yrist. With37 Diagrams. pp. 99. London: 1’riibner and Co. 1865.

Tgms is a most ingenious little work, showing how, by aseries of specific exercises, the muscles of the hand and fingersmay be so strengthened as to enable young persons to performon musical instruments without that wearing practice uponthe instrument itself which is at present the only receivedmethod of acquiring dexterity on the pianoforte, violin, &c.

Mr. Jackson has diligently studied the anatomy of the hand,and shows how little we ordinarily exercise the several musclesupon which rapid movements of the individual fingers depend.He has submitted his plan to several eminent anatomists,who fully endorse his novel views ; and we believe his workmay be advantageously consulted by those who have youngpersons beginning the study of music under their charge, or byany, in fact, who desire to gain great flexibility and dexterity

’ of their hands-medical students and young surgeons to wit.

De la Résection du Genou. Par M. LÉON LE FORT.

, THIS is an essay on Excision of the Knee, written in 1859,- and published among the " M6moires de la Societe de Chirurgie-i de Paris" in 1864, but without addition or alteration. Hence3 the value of the essay as regards the estimation of the opera- tion in both England and France is somewhat diminished,

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since within the last few years British surgeons have becomemore careful in the selection of their cases ; whilst French

surgeons, and among them MM. Follin, Gosselin, Dusseris,Yerneuil, Giraldes, Surbled, and the author, have introducedthe operation with success into French practice. M. LeonLe Fort visited England in 1858, and he gives here the resultof his observations at the several metropolitan hospitals, anda ’table of cases operated on up to 1859. The literature of the

subject of excision of the knee has recently been enriched bythe late Mr. Price’s essay, and we presume we may expect anot less valuable contribution from the successful candidatefor the Jacksonian essay on the same subject, now undergoingadjudication.

The Skin Errcptioit of the Cattle Plague. Photographed fromNature. Life Size. By ALEX. BALMANNO SQUIRE, M.B.Lond., &c. Churchill and Sons.

OUR high opinion of Mr. Squire’s coloured photographicrepresentation of skin diseases has been already strongly ex-pressed. We have now to thank Mr. Squire for a most oppor-tune representation of the much-debated eruption of cattleplague, executed in a way which makes it worthy of its pre-decessors in the series. Mr. Squire says, in his short but cleardescription of the eruption, that he has found it most developedon the udder and around the teats. Accordingly he has photo-graphed one of the teats with four crusts on it, which hethinks could originate only in pustules. The photograph is avery beautiful work of art, and must be regarded as givingthe best idea of the eruption which can be obtained withoutseeing it in nature.

PNEUMONIA AND VENESECTION.To the Editor of THE LANCET.

SIR,-As Professor Bennett has more than once alluded inyour journal to remarks made by me in a clinical lecture onbloodletting, perhaps you will kindly allow me to say a fewwords on his two interesting cases of pneumonia published inyour last number.

Professor Bennett gives them to show, by comparison, thegood effects of the restorative treatment (as he terms it), andthe ill effects of bloodletting in pneumonia. I cannot admitthat the comparison is in any sense a just one. His first caseis that of a man who, it appears, had had some years previouslyacute rheumatism; and, in addition to the pneumonia, was thesubject of organic heart disease. Here there was a complica-tion of diseases; and as Professor Bennett gives no further ac-count of the heart affection, beyond telling us that there wasa blowing murmur at the heart’s apex, we are left to conjec-ture how much of the difficult respiration depended on theheart affection, and how much on the pneumonia-that is tosay, we have no means of judging how much of the cure inthis case of chronic heart disease depended on the mere tran-quillizing (by rest, &c.) of the heart’s diseased action. Ahawker, exposed to severe weather, and the subject of organicheart disease, is just the case which we should à priori expectto recover rapidly from lung affection, in so far as that lungaffection was produced by exposure and over-exertion. Tran-

quillizing the heart would be the first step in the case.Professor Bennett’s second case, as showing the ill effects of

bleeding, is still more unsatisfactory. I have just as good aright to say that the bleeding saved the patient’s life as Pro-fessor Bennett to say that it prolonged his convalescence. Thepatient appears to have been the subject of kidney disease aswell as of pneumonia. His urine was albuminous when he- entered the hospital, and was albuminous when he left it ; andProfessor Bennett heads the case, double pneumonia, albu-m,nuria. Now, I should like to ask Professor Bennett, whetherhe would not expect, from the very nature of the case, that aman suffering from pneumonia plus disease of the kidney,would be likely to recover much more slowly than a man suf-fering from pneumonia plus cardiac disease of the kind sup-posed in Professor Bennett’s case ? Surely he will answer "yes";and if so, then clearly he cannot fairly attribute the lingeringillness to the bleeding. He will much more reasonably attri-bute it to the unhealthy condition of the body, which is neces-sarily associated, with organic kidney-disease. Neither does

his first case show that bleeding would not have been of greatservice to the patient. Surely it is no light matter for a manto be the subject of urgent dyspncea and acute pain in the sidefor a whole week, to suffer for a week severe symptoms, whichthe loss of a few ounces of blood might immediately and per-haps effectually remove.Be this as it may, I am sure those who carefully read these

two cases will agree with me that they are not capable of justcomparison, and that they offer no satisfactory data fromwhich to judge of the real effects of bleeding in acute affectionsof the chest.One word more as to the word "restorative," which is apt

to mislead. Surely everyone may call his treatment I I restora-tive ;" for what is his intention but to restore the patient tohealth ? Professor Bennett, however, would make it appearthat there is something antagonistic between bloodletting andgiving the patient nourishment, support, and stimulants. Butthis is quite a mistake. In my view the bleeding is employed,not to cure the inflammation, but simply and solely to relievethat degree of painful congestion of heart and lungs which isone of the occasional consequences of pneumonia, and of itselfendangers life, and interferes with recovery, by oppressing allthe organic functions. I would and do give "restoratives" "equally with Professor Bennett, and admit nothing antago-nistic between the giving of restoratives and the letting ofblood. I have again and again said, and I wish I could im-press it upon my friend Professor Bennett, that the bleedingis in no sense to be considered as a cure for the pneumonia. Idon’t believe that bleeding ever did or ever will cut short acase of pneumonia; but I do believe that in those compara-tively few cases in which the inflammation is accompaniedwith urgent dyspncea, bleeding moderately will not only givegreat and immediate relief from most painful symptoms, butwill also, by the’very fact of this relief, enable us more effec-tually to administer requisite restoratives.

I am, Sir, your obedient servant,W. O. MARKHAM.Harley-street, Feb. 5th, 1866.

VENESECTION IN ITALY.To the Editor of THE LANCET.

’ SIR,-Having observed a paragraph in last week’s numberof THE LANCET, headed " Venesection in Italy," in which(quoting from the Reader) it is stated that my late uncle, SirCharles Eastlake, had fallen a victim to a merciless course ofbloodletting, I think it right to correct an error upon thispoint, which has by some means crept into several journals.In September last I was summoned to Milan to attend my

uncle who was alarmingly ill with pneumonia. To my grief Ilearnt on my arrival that the Italian doctors in attendancehad taken blood from the arm once, but I fortunately came intime to prevent Sir Charles from being subjected to those fre-quent bleedings to which the late Count Cavour and manyothers have undoubtedly fallen victims. It is, of course, a

very painful subject for me to touch upon, but in a spirit ofwarning to those who travel in Italy, I think it only my dutyto caution them against the medicinal treatment of acutediseases which exists even amongst the most eminent Italianphysicians. Not only was Sir Charles deprived of any kind ofstimulants and kept upon the lowest possible diet before Icame to him, but I found that he had been most cruelly blis-tered and subjected to a long and baneful course of mercury.It is, I feel, due especially to the latter that a good constitutionwas thoroughly undermined. A grain of calomel had beenordered every two hours, and had been given for many daysand nights, which produced the most distressing salivationand obstinate form of dysentery which it has ever been mypainful duty to witness. Although Sir Charles sufficientlyrecovered from this condition after a few weeks to attend tohis official duties, his subsequent journey to Pisa told upon hisshaken system, and after lingering for two months his vitalpowers at length succumbed.

I remain. Sir- vour obedient KervH/nt.

HENRY E. EASTLAKE.Welbeck-street, Cavendish-square, Feb. 186(

MEDICAL MEN IN THE ITALIAN PARLIAIlTENT. - Welearn from L’Imparziale that eighteen medical men have seatsin the present Italian Parliament-viz., eleven in the Chamberof Deputies, and seven in the Senate. Out of these eighteenmedical men, three among the deputies, and four among thesenators, are editors of medical journals.