"mixed cases," that we are forced to look for some other explanation rather than to believe that two things which are so often convertible have originated from distinct seeds.

But it is not merely upon the question of unity and duality that Mr. Bradley's little work offers some useful information. The appendix contains a short paper upon syphilitic renal dropsy, and another upon syphilitic post partum hæmorrhage, which are very suggestive. It is only of late years that we have learnt how numerous are the manifestations of syphilis, both congenital and acquired, especially in the internal parts of the body. There are few branches of pathology which have made greater progress than this, and syphilitic lesions are now detected in many situations where the surgeons of the last generation never suspected them. Though Mr. Bradley's observations are too few to warrant him in speaking decidedly, it seems reasonable enough to suppose that in the cases he narrates syphilis was the root of the mischief.

We have lately had to notice in the pages of this Review some large and comprehensive treatises on syphilis. With these Mr. Bradley's little monograph can hardly be said to enter into competition; but, as far as it goes, it is a useful and suggestive book, and indicates original thought and honest work. Though it contains some speculations with regard to the origin of syphilis, and some rules for treatment, to which we should be inclined to take exception, we can in the main recommend it to those surgeons who are interested in the subject—and which of us is not ?-as a book which will be read with pleasure, and which can scarcely fail to awaken thought upon some most important propositions.

On Case-taking.1-These two pamphlets serve to show the importance which is now attached to case-taking; in fact, it is becoming a thing essential to the progress of our art to have faithful and intelligent reports of the cases which pass through our hands. If medicine and surgery are ever to become more exact and scientific than they now are, it can only be by inductions based upon a large area of well-noted and well-classified cases.. A conviction that this is so is rapidly gaining ground, and in all directions efforts are being made to render more available the vast quantities of material which are annually collected in the case-books of hospitals and infirmaries. At some of the metropolitan medical schools there is an instructor appointed to teach the students how to take notes of cases, and at most of them there are registrars whose duty it is to

1 Note-book for Cases of Ovarian and other Abdominal Tumours. SPENCER WELLS. Third edition. London, 1871. Pp. 25.

By Mr.

2. Suggestions for a ready Method of Recording Surgical Cases in Hospital Practice. By EDWARD LUND, F.R.C.S., Lecturer on Anatomy, and one of the Surgeons to the Manchester Royal Infirmary. Manchester, 1872. Pp. 17.

keep such records, and to draw up such tables, as shall help to make the work of the wards useful in the advancement of the healing art. But the truth is that to take a case well is a very difficult matter, and presupposes both knowledge and experience together with some facility in writing and expressing ideas. It is, in fact, the applications of the art of the essayist to each individual case; and every schoolboy knows how difficult it is to write a good essay, to touch upon all the salient points of the theme, and to make the whole complete and self-explanatory. Now, just as at the public schools a lad who has the gift of writing a good essay is rare, so is it among medical students. The major part cannot be expected to draw up satisfactory records of the cases that they have under their charge without direction. We have no doubt that when all has been done that can be done by well-devised note-books, it will still require some preliminary instruction and constant vigilance on the part of the surgeons and physicians themselves if their cases are to be well recorded and well indexed.

Premising, then, that we must not expect too much from medical students in an art which is confessedly far from an easy one, and that constant supervision on the part of their teachers is necessary, we turn to the pamphlets before us. Mr. Wells' brochure has now reached a third edition, and is highly appreciated by all who are interested in the particular class of cases to which it refers. As we run our eyes over the pages, and observe how carefully every item in the patient's history which can have any bearing upon the disease is noted and delineated in diagrams, we have a clue to the remarkable success which has attended ovariotomy of late years, and has served to establish its position among the most brilliant of the great achievements in operative surgery.

The main object of Mr. Lund's pamphlet is to recommend a system of abbreviations which have been suggested to his mind by studying those which Donders has introduced into ophthalmic practice. But there is this difference, that, whereas the Utrecht Professor has proposed a limited number of symbols for words which are constantly occurring in eye surgery, Mr. Lund would like to see a system of "long shorthand" adopted, whereby all words and sentences would be abbreviated. To us this method appears difficult, and on the whole liable to give rise to mistakes. To report cases on Mr. Lund's model the student would need to acquire a kind of stenography in addition to all the other branches of knowledge which now claim his attention. Though we heartily concur with Mr. Lund in his desire to see better and more available records of the cases which pass through our great medical institutions, we believe that the unabbreviated system proposed by Mr. Wells is more likely to be generally adopted than the shorter but more complicated one which he recommends.

Lawson on Sciatica, Lumbago, and Brachialgia.1-Some books derive a special value from the strictly personal experience they contain. Doctors are often, very often, bad patients, for in the study of their own cases they are apt to lose all mental perspective, and mix up in worrying confusion the grave and trifling symptoms of their ailments. Now and then, however, and especially in chronic disease, their powers of observation assume their best form, and then medical men become capable of educing from their own suffering knowledge of permanent value to their fellow-men. In sciatica, a disease in which the patient is Prometheus-like reduced to a long contemplation of the evil which torments him, we have a condition which the medical mind can turn to profit. This has been well done in the book before us. The author, as we know, was for a long time. a very martyr to the disorder on which he now writes, and in these pages he has given us a most graphic description of his own case, and the method by which he was restored to health and usefulness.

The book is divided into ten parts or chapters, of which seven are devoted to sciatica and its treatment, the eighth and ninth to lumbago and brachialgia, while the tenth consists of a short review of the literature of these subjects. As regards the pathology of nervous pains, our author expresses himself strongly against the "visionary hypothesis" of the central origin of neuralgia. He very justly regards this view as purely speculative, and points out very clearly the absence of facts to support it. Venturing himself for a moment into speculation as to the part of the nerve primarily attacked, he says: "I have a strong suspicion that changes of nerve structure commence in those delicate filaments which form such exquisite reticulations on the surface of the sarcolemma of the muscle." His chief ground for this hypothesis is the beneficial action of local injections in sciatica. We can ourselves confirm this observation, and have no hesitation in saying that in some cases the distant hypodermic injection is valueless as compared with injection at the seat of pain. In the remarks on the associated conditions and causes of sciatica there is useful matter, but we regret that the author has not given more space to the connection between dyspepsia and sciatic pain. There are many cases in which dyspepsia and oxaluria form the key to successful treatment, and the frequent association of these conditions with neuralgic pain deserved more consideration. The diagnosis of sciatica, which at first sight appears an easy matter, is, as Dr. Lawson shows by reference to the many different opinions of his own case entertained by high authorities,

1 Sciatica, Lumbago, and Brachialgia; their Nature and Treatment, and their immediate Relief and rapid Cure by Hypodermic Injection of Morphia. By HENRY LAWSON, M.D., Assistant Physician to St. Mary's Hospital, &c. London, 1872,

sometimes a question of extreme difficulty. The word-picture of the affection drawn in these pages by one who is a master of literary art will suffice to save all readers from similar difficulty. No less than three chapters are devoted to treatment, and in these the value of internal remedies of epidermic, endermic, hypodermic medication, and of hygienic treatment, is fully discussed. Our author is no believer in specifics, but has great faith in the internal use of sulphurous acid in certain forms of dyspepsia associated with sciatica. The use of alcohol in some pure form is insisted on as most beneficial. Ether is mentioned, but has not been tried fully; we wish it had, as in our opinion it is preferable to alcohol in many cases, and is most valuable on account of its power of aiding the assimilation of fat, a substance most important in the nutrition of nervous tissue. Electricity is considered at length, and the remarks thereon are well worthy of attentive study, as, in fact, are all these chapters on treatment. "The true, and almost the only remedy for sciatica-the hypodermic injection of minute quantities of morphia❞—is considered last. To this mode of treatment the author owes his own cure, and he dwells on it with a natural gratitude. All he writes on this part of his subject is expressed with a care and earnestness which carry authority, and the sixteen cases (including his own) which are appended bear the strongest testimony in favour of the efficacy of morphia thus administered. After describing the form of syringe which is preferred, a solution of ten grains of hydrochlorate of morphia dissolved in two drachms of water is recommended as the best. "This solution is always solid at ordinary winter temperature, and generally so in summer. It contains half a grain of morphia in every six minims, and must be heated before each injection." The solidity has two advantages: it prevents decomposition and obviates mistakes in using the solution. Two minims (one sixth of a grain of morphia) is the dose recommended at first, and very careful directions are given as to the mode of injection, and the effects to be expected. At first, one injection in the twenty-four hours is considered sufficient; this may be followed by a larger dose, and in severe cases two or even three injections may be given daily. The practice of giving more than half to three quarters of a grain of morphia at one application is strongly objected to as far as regards sciatica. Hypodermic morphia when well borne generally increases the appetite, and thus the patient's general health is improved by the same means that remove the local pain. The number of injections required to effect a cure varies according to the severity and chronicity of the case. In some a few injections suffice, in others weeks or months of treatment may be necessary. In the graphic description of his own case the author says, "The injections had to be repeated nightly for many months. But this is certain, this is absolutely unquestionable: from the first application the patient improved." "In the whole range

of therapeutics I know of no instance where one remedy has produced so definite and wonderful a cure in so apparently hopeless and aggravated a case."

The chapters on lumbago and brachialgia are, we think, scarcely equal in merit to the earlier parts of the book, but both contain much useful information, and the cases recorded show strongly the advantage of the mode of treatment adopted.

The last chapter is a criticism of the views experienced by other writers. Throughout it there runs a healthy contempt for the visionary speculations on the origin of neuralgia, in which some recent authors have indulged. Good honest doubt is a feeling which cannot be too frequently expressed by medical writers in this age when the tendency to theorise is almost unchecked by the necessary severity in criticism. We congratulate Dr. Lawson on having boldly attacked this tendency, and we heartily recommend his book not only for its great practical value and pleasant style, but also for the wholesome absence of wild hypothesis.

Cobbold on Worms.'-The subject of internal parasitism is daily becoming more important in some of its aspects, and the prevalence of parasitic diseases is likely to increase with the development of our foreign meat supply. On this account the little book before us is welcome, coming as it does from one who has devoted himself most earnestly to the study of helminthology, and added much to our knowledge. Dr. Cobbold has hitherto been known rather as an enthusiastic naturalist than as a physician, but now comes before the profession in the new character of a practitioner, writing on the morbid conditions which he has specially studied.

The twenty lectures of which the book consists were delivered at the Middlesex Hospital, and give a short and clear account of the symptoms and treatment of the several intestinal worms. Trichiniasis, the Bilharzia hæmatobia, and Pseudhelminths are also considered.

Tapeworms occupy the first and larger portion of the book, and the symptoms produced by them and the means by which they are to be expelled are discussed at length. No less than forty-two cases of tænia are quoted in illustration of the author's views. The remedy he most generally relies on is the extract of male fern, but areca-nut powder, kousso, and other remedies are occasionally prescribed, some cases well illustrating the fact that when one remedy fails another will sometimes succeed in dislodging the invader. In his practice Dr. Cobbold oftentimes discountenances immediate treatment, especially when a portion of a tapeworm has been recently got

1 Worms. A Series of Lectures on Practical Helminthology, delivered at the Medical College of the Middlesex Hospital; with Cases illustrating the Symptoms, Diagnosis, and Treatment of Internal Parasitic Diseases. By T. SPENCER COBBOLD, M.D., F.R.S., &c. &c. London, 1872.