aperture of the glottis, and to enter the laryngeal cavity. The instrument being prepared by suitably saturating the sponge with the solution to be applied, the head of the child being firmly held by an assistant, and the base of the tongue depressed with a spoon, the operator carries the wet sponge quickly over the top of the epiglottis, and on to the laryngeal fall of this cartilage; then, pressing it suddenly downwards and forwards, passes it through the opening of the glottis into the laryngeal cavity. If any patches of false membrane are to be observed upon the pillars or tonsils, the sponge should be passed freely over those parts, and also upon the posterior wall of the pharynx.

M. Bretonneau, who was one of the first to recommend and employ the nitrate of silver as a topical remedy in the treatment of membranous croup, made no attempt to pass the instrument below the epiglottis. M. Guersent applied the solution in such a manner as to cause some drops of it to penetrate into the larynx. We have ourselves very recently heard some excellent clinical observations upon this subject at the Hôpital Neckar by M. Trousseau, recommending this remedy in croup. The French practitioners, however, employ a much stronger solution than that recommended by Dr. Green. For example, M. Bouchut, in a recent work on 'Diseases of Children,'* advises the application of a solution in the proportion of one of the salt to three of water; and M. Guiet, in his thesis entitled 'Considérations Pratiques sur le Traitement du Croup,' proposes a still more concentrated solution; namely, equal parts of the nitrate of silver and distilled water. The author has found a solution composed of from two scruples to a drachm of the salt, dissolved in one ounce of distilled water, to answer all practical purposes. Dr. Green has also found beneficial results attend the application of the nitrate of silver in cases of diphthérite, or the croup of adults. M. Louis, who gives a graphic description of this disease, under the name of "Croup chez l'adulte," records only one case in which a cure was obtained by medical

treatment.

Having now concluded our analyses of the contributions to the pathology of children by Drs. Reid and Green, it only remains to remark upon their respective merits. The diseases which both writers have chosen for their theme are perhaps two of the most formidable, because the most likely to terminate suddenly in death, within the whole range of children's pathology; but how differently are they treated? Dr. Green, seeing the inutility of the ordinary or routine system of treating croup, boldly enters into a new field of inquiry, and with success. Dr. Reid is content to recapitulate the practice of others, so far as it is supported by his own experience. We have an invincible repugnance to a rechauffé of any kind unredeemed even with an air of novelty, but above all, to one of medical truisms; and it is our deliberate opinion that if an author has nothing new to offer before he rushes into print, he will do well to bear in mind that wholesome maxim of the Koran, which ordains, "If speech be silver, silence is gold!"

• Manuel Pratique des Maladies des Nouveaux-Nés, et des Enfans à la Mamelle.

ART. IX.

Pathological and Practical Observations on Strictures, and some other Diseases of the Urinary Organs. By FRANCIS RYND, M.A., M.R.I.A., Surgeon to the Meath Hospital, and County of Dublin Infirmary, &c. &c. &c.-London, 1849. pp. 196.

THERE is a large class of works in medicine and the collateral sciences, which contain but little of absolutely new matter, and which are still, notwithstanding the deficiency, acceptable contributions to the literature of our profession. Some are meritorious, on account of their laying unwonted stress upon facts that have long been known, but insufficiently attended to in practice. Others, again, are valuable because of the style in which they are written, the fidelity with which they are compiled, the felicity with which they are illustrated; and besides these, there yet remain a large and valuable section which in some measure combine a portion of all these excellencies. We allude to works which present a clear résumé of the pathology and treatment of certain classes of diseases, that have engaged the particular attention of their authors, and in whose composition acquaintance with the experience and labour of others has been associated with personal observations and a thoughtful habit of mind; of such a character is the work before us.

Mr. Rynd presents us in the present volume with a very clear and intelligent treatise, in which thought is blended with experience, and research with practice; and from the perusal of which, although we do not agree in all the opinions that are advanced, we have derived both profit and gratification. As a specimen of views from which we dissent, it may be stated that Mr. Rynd denies the influence of gonorrhoea in producing stricture, and sneers at what he calls a "post hoc propter hoc fallacy." In this we think he is mistaken. It is not a violent gonorrhoea, which runs an acute course in a reasonable period, or stimulating injections employed in its cure, that we believe predispose to stricture; but it is the residue as it were of the disease, the long-continued and scarcely-noticed gleet, which lays the foundation of the complaint. So long as the mucous membrane of the urethra secretes an unnatural amount of fluid, it is in a state of excitement; it is redder and more vascular than ordinary; it exceeds by so much its healthy function; and as this continues sometimes for months, it is manifest that changes must take place in it. Accordingly it becomes thickened, loses its vital elasticity, and in parts begins to contract. It is no argument to say, as Mr. Rynd does, that the majority of persons affected with gonorrhoea escape stricture; the question is, does stricture follow gonorrhoea sufficiently often to bear out the relation of cause and effect?

Mr. Rynd considers stricture to be occasionally hereditary, and cites the case mentioned by Hunter of a boy, four years old, with stricture and fistula in perineo, as corroborative of this view; but to us the proof is incomplete.

In applying anatomical and physiological considerations to the inquiry into the causes of stricture, our author makes the following observations, which we transcribe, as not only very plausible in themselves, but as offering a good example of his style.

"Let it be recollected that the membranous portion of the urethra forms a curve under the firm and resisting ligament of the pubis, which curve will have a tendency to become an angle, according as the bladder becomes distended and rises upwards in front of the abdomen; and the angle so formed will, by flattening and compressing the canal in its transverse direction, render the passage of the urine proportionately difficult through it. Any one who has in his own person experienced the delay and trouble of emptying an over-distended bladder, that has seen the water first come by drops, then in a small thread-like stream, and not assume its wonted freedom and size until the discharge is nearly completed, will readily comprehend the effect of this change in the direction of the canal upon it. This may occur in perfect health, even to the extent of producing retention of urine, and perhaps some of the cases attributed to loss of tone in the muscular fibres of the bladder might be as truly explained thus; but in the next place, let it be supposed that from any cause Wilson's muscles should be seized with spasm in any of these cases already affected by the over-distension, and it must so shut up and close the urethra at that angle as to occasion absolute retention. The patient, then, in his efforts to relieve himself, will direct all the force of an excited bladder, aided by that of the abdominal muscles, on this very spot, already probably in a state of irritation, and disposed to become inflamed, and thickened and resisting; and let it be further imagined, that this shall happen again and again, at every repetition the mischief will be increased, until a permanent alteration of structure is finally induced." (p. 11.)

Mr. Rynd considers it doubtful whether rupture of the bladder ever occurs as a consequence of mere mechanical over-distension of urine, but states that the accident is always preceded by pathological changes, which soften its texture; and adds, that the rupture, in his experience, happens in the portion of bladder that is covered with peritoneum, the effusion being poured into the proper abdominal cavity. We subjoin a highly interesting case from Mr. Rynd's book, of recovery from rupture of the bladder.

"A boy, about ten years of age, standing on a dray or float on which there was a cask of sugar very imperfectly secured, unfortunately occupied the space between the front of the cart and its lading, when the horse accidentally fell, and the cask rolling forward jammed him against the cart, and crushed him frightfully. He was brought to the hospital with his pelvis extensively shattered, his left thigh broken just below the trochanter, and, as very shortly appeared, his bladder ruptured also. He suffered intense pain, especially in the abdomen, which he could scarcely allow to be touched, but as the obvious injuries were so extensive, the pain was chiefly attributed to them; and he was placed in bed, and had some warm drink and other restoratives administered previous to being dressed. He very soon expressed a desire to pass his urine, but could not void a drop, and a catheter was then introduced, which drew off a very small quantity, deeply tinged with blood, but afforded no relief. These symptoms continued with great severity for several hours, except that sometimes urine flowed through the catheter, as if on these occasions its beak had been pushed through the rent into the dépôt beyond it; but generally it did not, and in either case there was little or no alleviation of the distress. After the first twelve hours, the instrument always came out stained and blackened by sulphuretted hydrogen, and my colleague, Mr. Porter, under whose care he was, remarked this as being a fatal symptom, having never seen recovery after it,-a prognostic in which he was most agreeably disappointed. At the end of about forty-eight hours a small abscess pointed at the left side of the navel, which being opened gave an exit to an immense quantity of fetid pus and urine; this aperture became fistulous afterwards, and discharged clear and healthy urine whilst he remained in the hospital, which was more than three months. This boy recovered, and was seen and examined by several surgeons more than a year afterwards; the

wound in the abdomen healed, and the water passed by the natural canal; but of the pathological process by which so fortunate a termination was obtained no one could form a conclusive opinion. It may be surmised that the extravasated urine had been more or less circumscribed, that it had induced inflammation, which poured out coagulable lymph, and thus formed a cyst, within which the fluid was completely insulated; but how it came to be regularly expelled afterwards, or what contractile force was exerted on it-in a word, how this newly-formed sac came to perform the functions of a bladder, as it seemed to do, is a problem, the solution of which surpasses my ingenuity." (p. 48.)

Our author makes some capital observations on urinary fever, and its liability to be confounded with intermittent fever and ague-a mistake which he has known to occur. He is an advocate for puncturing the bladder above the pubis, when all means fail of removing the urinary distension; and he states that this operation is preferred in Dublin to any other under these distressing circumstances.

In the course of the next chapter, which relates to the pathological symptoms of stricture, the author takes occasion to observe how sympathetic affections, seated in a different and somewhat distant part, occasionally mask the real disease and withdraw the attention from it. He has known a patient treated for piles whilst the real disease was stricture. The urine flowed away occasionally from the distended bladder and thus deceived the practitioner; whilst the piles, which were dependent upon the straining in making water, were alone subject to treatment. respect to the treatment of stricture by caustics, the nitrate of silver of Sir Everard Home, or the caustic potash of Mr. Whately, the practice is condemned as uncertain and hazardous; an opinion for which reasons satisfactory to our mind are advanced by Mr. Rynd. He gives the highest praise to opium, employed freely during the dilatation of strictures by the bougie, and this accords with the experience of English surgeons.

In

The subject of fistula in perineo and its complications are treated of in this book in a remarkably clear and judicious manner. The remarks are too long to be transferred to our pages, and an abridgment of them would incur the danger of obscurity, but they may be read with profit by all reflecting surgeons. It may, however, be observed that their principal end is to inculcate the paramount importance of paying great attention to the condition of the urethra previous to attempting the cure of the fistula. A fistula Mr. Rynd defines thus:

"A complete fistula may be regarded as a long abscess with two small apertures, neither of which is sufficiently large to give free exit to the matter that is constantly in process of formation, some of which must be as constantly seeking to escape from it, and thus keeping the orifices open and unhealed; an incomplete is exactly a similar abscess, only that it has but one aperture instead of two." (p. 131.)

Acting on the supposition contained in this definition, deep and extensive incisions are wholly unnecessary for the cure of fistula; all that is required is a large external opening in a depending position, so as to prevent the lodgement, and facilitate the discharge of all extraneous matters, including the secretion of the fistula itself. This proceeding, which is a much less serious one than that ordinarily adopted of laying open the sinus throughout its entire extent, has been attended with perfect success in the hands of Mr. Rynd.

The concluding chapter of the work is occupied by the consideration of

dysuria produced by affection of the prostate gland. We quote the following passage relating to enlargement of the third lobe of the prostate gland:

"When the middle lobe begins to enlarge, it cannot swell in a posterior direction, on account of the firm and unyielding nature of the vasa deferentia, which pass exactly behind and beneath it; it therefore pushes upwards into the cavity of the bladder, where it appears as a nipple-shaped tumour, varying in size from that of a small filbert to a walnut, and even more; and if at the same time the lateral lobes remain unaltered and of their usual size, the swelling draws with it a fold of the mucous membrane, which lies like a festoon on either side of it. The urethra, in this case, is compressed from before backwards, as well as elongated, and its vesical orifice resembles a transverse slit, with its posterior lip larger and more pouting than the other. Retention of urine now happens, by the stream of urine pushing forward the tumour against the orifice of the urethra, which it covers like a valve, the occlusion being in some instances rendered more perfect and complete by the festoon-shaped folds of membrane just described." (p. 165.)

In the treatment of this disease, Mr. Rynd proposes a silver catheter, where there is no obvious and decided objection to its use. The concluding pages treat of abscess in the prostate gland, which are divided into acute and chronic, the latter form being illustrated by the detail of two very instructive cases.

Here we must bring our notice of Mr. Rynd's treatise to a conclusion, not because we have exhausted its interest, but because the space at our command is limited, and we have already said, enough to give a fair sample of the work. It is, without doubt, an able and thoughtful production, and has our cordial recommendation as one of the best of the modern contributions to this branch of surgery.

ART. X.

1. On the Nature of Limbs. A Discourse, delivered at an Evening Meeting of the Royal Institution of Great Britain. By RICHARD OWEN, F.R.S.-London, 1849. 8vo, pp. 120. With Four Plates.

2. The Homologies of the Human Skeleton. By HOLMES COOTE, F.R.C.S., Demonstrator of Anatomy at St. Bartholomew's Hospital.-London, 1849. 8vo, pp. 100.

PROFESSOR OWEN'S "Discourse" may be regarded as in reality a continuation of his work on the 'Homologies of the Vertebrate Skeleton,' noticed by us in our Second Volume, (p. 107); the purpose of it being to present in a more expanded form those views of the "General and Serial Homologies of the Locomotive Extremities," which were only briefly hinted at in his former work. Following the plan we pursued with regard to it, we shall endeavour to make our readers acquainted with the general idea which Professor Owen has in view; referring them to the work itself for the details of its development.

Every comparative anatomist is prepared to admit that the "arm" of man, the "fore-leg" of the beast, the "wing" of the bat or bird, and the "pectoral fin" of the fish are answerable or homologous parts; and in like manner he recognises the conformity of the lower extremities of man with the posterior limbs of beasts and birds, and with the ventral fins of fishes, notwithstanding that these last may be situated in immediate con