and Laroyenne. The simple sore, on the contrary, as is well known, is capable of inoculation again and again.

The syphilitic sore cannot be cut short by excision or cauterization, however early, of the sore and its neighbouring structures. This is proved by the testimony before the Venereal Committee.

The author considers that syphilis is a true toxæmic poison capable of being entirely eliminated, and not constituting when the system is invaded, a real diathesis, but followed sometimes by a cachexia which is the result often of debility, debauchery, poverty, and mercury combined.

The author does not discard the use of mercury entirely; on the contrary, he considers that in the true syphilis we have no remedy equal to it, but he recommends it to be used as rarely and as carefully as possible. Out of the carefully watched cases of primary syphilis under his own care and very favorable circumstances in the Mountjoy Convict Prison, only two required mercurials to accomplish a satisfactory cure.

The author believes that we cannot by any kind of treatment prevent the constitutional infection, in this respect adopting the opinion embodied in the report, and founded upon the evidence brought before the Venereal Committee. The cases which our forefathers took as proofs of the efficacy of the administration of mercury in the prevention of secondaries were, he thinks, cases of simple ulcer mistaken for true syphilis. He ascribes the honour of the first introduction of iodide of potassium as a remedy to Wallace, and the first scientific study of the natural history of syphilis to Carmichael. With respect to the practice of syphilisation, first tried upon animals by Auzias-Turenne in 1850, and afterwards followed out by Böeck in the human subject, he adopts the opinion expressed (after experiment in 259 cases upon Böeck's plan), by Messrs. Lane and Gascoyne, of London, viz., that syphilisation is not a treatment which can be recommended for adoption," and its results "not sufficient to compensate for its tediousness, its painfulness, and the lifelong marking which it entails upon the patient." He agrees with Mr. Gascoyne that an early and uncomplicated syphilis has a great natural tendency to recover of itself, and that this is sufficient to explain the good results which sometimes occur after syphilisation. Cleanliness and the early use of washes and detergent lotions he considers to be a great preventative of the disease. The author thinks highly of warm and vapour baths, either simple or medicated, and of the sulphur waters of Harrogate and Kreuznach, in syphilitic affection of the skin.

The style of the lectures is free, flowing, and easy, and constitutes very pleasant reading, satisfactorily conveyed in a very plain and distinct type. In the last lecture he sums up the testimony of living authorities as to the cases in which mercury should be employed, by

quoting them in the way of question and answer as examined before the Venereal Committee; and his conclusion is that "the vast majority of well-informed practitioners in the present day do not give mercury until they are certain that the case is one of true constitutional syphilis. Most of the eminent hospital surgeons both in England and Ireland, however, still adhere to a moderate course of mercury in the primary symptoms of hard chancre. One, Mr. Erichsen, still advocates its use in both soft and hard sores; while the military surgeons mainly discard its administration altogether, and Mr. Longmore thinks in addition that the secondary symptoms are more manageable when it has not been used. The author concludes his pleasant and instructive lectures by a light and humorous sketch "more Hibernico," of the modern revolution in the domain of King Mercury by which he has lost much of his temporal power, the revolt headed by the Garibaldi of venereal revolutions, the illustrious Ricord, and much forwarded by the "mob orator" Paul Diday.

Gamgee on Fractures.'-This, though a new work, is the expansion of various papers and teachings of the author during the last twenty years, especially in relation to the employment of immovable apparatus in the treatment of fractures, a subject to which Mr. Gamgee successfully turned his attention early in life. The lectures are singularly controversial for the audience of students before which they were delivered, but the students of Queen's College, Birmingham, have no cause to complain of want of clearness or of absence of dogmatic teaching on the part of the lecturer, though his views may not in all respects commend themselves to his brother practitioners.

In his first lecture Mr. Gamgee quotes Gross on the importance of the subject of fractures and their treatment (which nobody would deny), and then proceeds to dissect South (on Chelius), Le Gros Clark, and Hornidge for their opposition to immediate reduction and circular compression in cases of fracture in which swelling has already supervened. Seven cases are then quoted to illustrate the success of Mr. Gamgee's treatment by immediate reduction and the use of the starch bandage in examples of fracture complicated with spasm, blebs, extravasation of blood, and inflammatory swelling.

The second lecture is devoted principally to exposing the error of Pott (for whom, however, Mr. Gamgee expresses great admiration) in attributing the displacement, and especially the eversion, of a fractured limb entirely to muscular action. The now exploded teaching of Duhamel and Dupuytren as to the necessity for provisional callus is also severely reprobated since "the treatment of a

On the Treatment of Fractures of the Limbs. By SAMPSON GAMGEE, Fellow of the Royal Society of Edinburgh; Surgeon to the Queen's Hospital, Birming ham. London, 1871. Pp. 296.

fracture is perfect in proportion as the thickening at the seat of injury is slight, as in our cases."

In his third lecture Mr. Gamgee discusses the treatment of fractures by suspension and flexion, advocated especially by "the late Matthias Mayor, the impulsive and too exclusive, but always philosophically suggestive surgeon of Lausanne," as contrasted with the method by extension and immobilisation; and the author concedes that the swing is most useful in the treatment of fractures by securing immobility of the fragments, and, though this he would probably not concede, by relaxing muscles which tend to produce displacement. Liston's teaching is approved by Mr. Gamgee, though his practice in respect of the Macintyre splint is reprobated, and Liston's "long splint" is defended from the assaults of Mr. Syme, which are freely criticised. The latter surgeon's method of treating fractured thigh with a splint and folded sheet is shown to be a less complete method of securing immobilisation than the author's favourite starch bandage.

The practice of circular compression in fracture is considered in the fourth lecture, where it is shown that modern authorities who disapprove of it "but echo the teaching of the Macaulay of surgical literature, Mr. John Bell, from whose full and eloquent, always inspiring, though not unfrequently misleading, work" the author gives a long quotation. Mr. Gamgee maintains, on the contrary, that "the gentle and perfectly uniform, the evenly distributed and in no way constricting action, which I understand by compression, as applied in the treatment of fractures, is a therapeutic agency than which I know none more demonstrably beneficial," and he quotes several very well-marked cases in support of his views.

In the fifth lecture Mr. Gamgee discusses the cause, physiology, and mode of overcoming spasm in cases of fracture, and reiterates his statements respecting the effects of compression.

The sixth lecture is devoted to the special advantages of compression and immobilisation in fractures complicated with swelling or with penetrating wounds, and has a valuable addendum in a translation of a pamphlet by Professor Vanzetti on the treatment of inflammation by digital compression.

The seventh lecture is devoted principally to the treatment of compound fractures, in which Mr. Gamgee advocates infrequent dressings, and calls attention to Greenway's and Restall's swings for supporting broken limbs.

The eighth lecture is chiefly historical, being a résumé of the various views on the treatment of fractures from the time of the Greeks to the present day. A passing reference is made to Mr. Lister's views on antiseptic treatment, only to condemn it as neither new nor true. This lecture is followed by a section of some fifty pages, perhaps the most valuable in the book, giving plain and prac

tical directions for the construction of the various forms of starch apparatus for the treatment of the several fractures. The writer, by the way, very properly points out that the term "starch bandage is misleading, since without the addition of paste-board splints the bandage is of little service. He describes also the methods of using plaster of Paris and gutta percha, but his predilection is evidently for the starch bandage with paste-board splints applied over cotton wool.

The work is essentially original in its mode of discussing the subject it embraces, if the method principally inculcated is not entirely novel in the present day. The lectures contain many very useful hints and suggestions, and the author's practice appears to be founded on true principles. At the same time we rather pity the class to whom the lectures were addressed; the self-assertion, the verbiage, the repetition must have all been very trying to an audience, unless carried away by the author's enthusiasm, which may possibly be contagious. As a book the lectures sadly need compression, and the teachings of the author suffer from the form in which they are presented: At the same time we must repeat that the work is one of much value.

Milton on Gonorrhoea.-To write upon gonorrhoea is no easy task. It is a disease which so frequently touches moral questions of great importance to society that it needs to be handled with peculiar delicacy, and it has been treated with such a multitude of "specifics," and in such a variety of ways, that it requires careful discrimination to separate the chaff from the wheat.

Gonorrhoea is a subject to which Mr. Milton has long given a large share of his attention, and indeed the volume before us is only a digest of what he has previously published upon this and kindred topics. It is evident also that he has had extensive opportunities of treating the disease both in public and private practice. He is therefore fully entitled to speak with authority; and yet we doubt very much whether the views he holds and the principles of treatment he advocates will recommend themselves to the present generation of surgeons. In our opinion his remedies are unnecessarily severe for such a simple complaint as gonorrhoea generally is. If we can in a few days cure, almost with absolute certainty, the ophthalmia neonatorum by means of a simple alum lotion used every half hour, why should we have recourse to the much more hazardous solutions of nitrate of silver for the arrest of gonorrhoea? When perfectly safe means are sufficient for our purpose, the surgeon is not justified in using lotions, which may induce stricture of the urethra, though our author makes very light of the risk. Moreover, Mr. Milton is, in 1 On the Pathology and Treatment of Gonorrhoea. By J. L. MILTON, Surgeon to St. John's Hospital for Diseases of the Skin. London, 1871. Pp. 219.

our opinion, much too fond of applying the solid lunar caustic to the interior of the urethra. We thought this practice had well nigh ceased with the death of Mr. Wade.

There is a good deal of repetition in Mr. Milton's work. It might have been considerably curtailed with advantage; and it contains many short digressions, which are irrelevant to the subject in hand. The manner too in which he sometimes turns aside to make an attack upon modern methods of practice, or modern lines of study, is unworthy of a man who has much valuable experience to give and many sound observations to offer. His opinions with regard to gonorrhoea would be more likely to command attention if he did not prejudice the reader by the way in which he puts them forward.

Bradley on Syphilis.-This little volume consists of general remarks upon the origin, varieties, and treatment of syphilis, with an appendix, which contains reprints of papers contributed to the journals, and which have all a connection with the main subject of the work.

Mr. Bradley has evidently had extensive opportunities of studying syphilis, and he is well acquainted with the literature of the subject. But he has not been contented merely to follow others. He has instituted a series of original experiments upon monkeys, kittens, and guinea pigs, and the results obtained by them form the most valuable part of his monograph. These experiments, which are well worth the attention of all who are interested in the questions at issue, go to prove the unity of the syphilitic virus. That there are two well-marked varieties of venereal sores, and that these two varieties generally "breed true," our author is willing enough to admit. But do they owe their origin to one and the same poison variously modified, or are they sprung from distinct seeds? This is the question upon which syphilographers are divided, and in this controversy Mr. Bradley sides with those who hold that there is no sufficient evidence in favour of a duality of poisons. The experiments which he made on animals, and in which he produced soft and autoinocculable sores by the secretion taken from well-marked Hunterian chancres in the human subject, go to show that the two varieties are interchangeable, and do not always maintain the distinctions, which they certainly ought to present, if they sprang from distinct sources. This is the conviction which has forced itself on the minds of many of our most thoughtful surgeons. While there can be no doubt about the general differences between hard and soft sores, there are so many cases which violate the rule, and which are called

Notes on Syphilis, with an Appendix on the Unity of the Syphilitic Poison. By S. MESSENGER BRADLEY, F.R.C.S., Lecturer on Comparative Anatomy, Royal School of Medicine and Surgery, Manchester. London, 1872. Pp. 48.