versá, in search of work; a westerly breeze,1 or a spurt of commercial speculation may for a few weeks give him full wages; but then comes the period of total stoppage, for which no provision has been made. The transition is almost immediate from abundance, or at least sufficiency, to absolute pauperism. This uncertainty, like the rapid changes of gambling, tends to demoralise the man, and almost to preclude any steady household economy by the wives; hence we find among them an amount of reckless imprudence, drunkenness, and squalid wretchedness greater than among the same class in manufacturing towns. I have stated that the indigent unemployed flock to the towns; unfortunately many of such immigrants bring with them not only the burden of poverty, but a capacity of submitting to privations, which acts as a pernicious example to other labourers, and hence we find in this town of commercial prosperity and wealth large sections of the people in the lowest scale of social, physical, and moral degradation. "There can thus be no difficulty in understanding why-1, typhus fever is never absent from Liverpool; 2, why, among a population so reduced by overcrowding and privations below the normal standard of health and strength, the slighest increase of public distress quickly converts sporadic typhus into the gravity of a fatal epidemic; and 3, why seaports like Liverpool and Glasgow, the resort of unskilled labourers, and especially of poor Irish, are so unfavorably placed on the lists of the Registrar-General returns of annual mortality." Dr. Trench, like all other experienced officers of health, is convinced that by far the most important preventive and prophylactic measure for the terrible health-evils which they have to grapple with in Liverpool, is the providing of better dwellings for the poor. He points to what has been or is being done in London, Glasgow, Newcastle-on-Tyne, and other towns, in the way of erecting model lodging-houses and cottages, and expresses his regret that "Liverpool does not take the lead in a matter in which Liverpool is more interested than any other town in the kingdom." It is fortunate that the corporation have so able and zealous a professional counsellor at their side as Dr. Trench, and we cordially trust that his representations will not have been made in vain. The matter in question is at every time of vital moment to the welfare of the town. 1 Whenever there is any long continuance of easterly wind, and consequent delay in the arrival of homeward-bound vessels in the Mersey, there is inevitably a large and sudden increase among the claimants of parochial relief. This increase of pauperism is always accompanied by an increase of typhus; and thus the records of a meteorological phenomenon, of an economic effect, and of a contagious disease are all imprinted on one and the same line of the death register." ART. IV. On the Electrolytic Treatment of Tumours and other Surgical Diseases. By JULIUS ALTHAUS, M.D., M.R.C.P. London, 1867, pp. 31. THIS small treatise is the substance of a paper recently read before the Medical Society of London. After allusion to the physical, chemical, and physiological effects of a galvanic current on living bodies, and explaining "what takes place in a galvanic battery which has been properly charged," the author proceeds to speak of certain microscopical observations on the changes undergone by animal structures under the influence of the continuous galvanic current, which led him to adopt the electrolytic treatment. He observed that no animal tissue whatever could withstand the disintegrating effects of the negative pole, and that the rapidity and force with which this disintegration is brought about are proportioned to the electro-motive force employed, and to the softness and vascularity of the structures acted upon. This electrolytic action of the negative pole is mainly composed of the mechanical action of the nascent hydrogen and of the chemical action of the free alkali developed along with the hydrogen. Experiments on living animals showed that considerable changes in the nutrition of the parts were observed as proximate and remote sequelæ of the operations. "It was then observed that a needle connected with the negative pole of the battery could be inserted into and removed from the body without causing any loss of blood; that the current used did not appear to give any pain to the animal beyond what was due to the introduction of the needle through the skin; and that the parts operated upon shrank sensibly after the operation, but that there was neither inflammation, suppuration, nor sloughing. If the negative pole was made to act upon blood-vessels, it was found that they were first filled with a foreign body due to disintegration of the blood, and round which afterwards a slow separation of cancellated fibrine took place. They were thus charged into solid strings wherever the current had been made to act." This being the case, the author thought that the current could safely and successfully be applied to parts of the body where shrinking and disintegration of tissue and obliteration of bloodvessels might be required for surgical purposes. After describing the battery and the apparatus required for the electrolytic treatment, Dr. Althaus proceeds to enumerate the various pathological conditions in which the treatment has been or may be expected to prove serviceable, and these are tumours, certain diseases of the blood-vessels, especially aneurisms, serous effusions, strictures, wounds, and ulcers. Cases are adduced illustrating the treatment in some of these affections. ART. V.-A Manual of the Operations of Surgery, for the use of Senior Students, House-Surgeons, and Junior Practitioners. Illustrated. By JOSEPH BELL, F.R.C.S. Edin., &c. Edinburgh, Maclachlan and Stewart; London, Hardwicke, 1866, 16mo, pp. 267. THIS is a modest and, we think, a useful little volume, which will compare favorably with its numerous competitors by Maunder, T. Smith, and others, inasmuch as it embraces several methods of performing various operations which have been invented since the publication of those works, is illustrated by woodcuts, though perhaps hardly sufficiently, and the woodcuts, although rough, are yet not so unpleasing as those given in Mr. Maunder's volume. The author very properly disclaims any originality for a work of this nature, and he also most properly gives his authorities for almost every part of his compilation; yet he writes in the style of one who has had some experience of his own on the living body; and the proceedings which he describes are, for the most part at least, feasible in practice. From this statement a few exceptions may, doubtless, be made; but hardly any of these manuals of operations on the dead subject are free from some descriptions which most people would find it impossible to realise on the living. To our minds the following must be classed in this category. In the operations for "perineal section," i. e. for opening the urethra and dividing a stricture when impassable to instruments, Mr. Bell gives the following directions:-" A full-sized catheter must be passed as far as possible up to the stricture, and held firmly in the middle line. . . . The urethra should then be opened over the catheter, the edges of the mucous membrane held to each side by silk threads passed through them, and the surgeon must endeavour to pass a fine probe into the opening of the stricture. If this can be done, it is comparatively easy to slit the stricture up," &c. (P. 248.) We have performed or assisted at numerous such operations, which we hardly think Mr. Bell can have done, or else his cases must have been very different to ours. The depth of the parts and the free bleeding renders it absolutely impossible to recognise the edges of the mucous membrane-at the apex of a conical wound, perhaps, two or three inches in depth; and to see anything like the opening of a stricture at such a depth, a man must have sharper eyes than surgeons on this side of the border can boast of. Another statement of Mr. Bell's on the subject of urinary operations would be read with much amazement in France:-"Internal division of stricture may be merely noticed here as of historic interest, but is now very rarely practised, and has justly fallen into disrepute, as being both dangerous and (in severe cases) impossible" (p.245). But, notwithstanding a few such statements as these, which we regard as either erroneous or at least incomplete, we have no hesitation in speaking in terms of much praise of Mr. Bell's book, as much exceeding most works of the kind in clearness of description, combined with brevity; and we would recommend it as peculiarly adapted to the use of surgeons in the army and in distant colonies, for whom a portable and at the same time a tolerably complete manual, brought down nearly to the present day, is certainly a desideratum. ART. VI.-Leprosy. By C. MACNAMARA, Surgeon to the Calcutta Ophthalmic Hospital. Calcutta, 1866, pp. 59. THIS pamphlet, a reprint from the Indian Medical Gazette,' contains a succinct and ably drawn-up analysis of the one hundred and seven reports of medical officers constituting the contents of the volume recently published by the Indian Government in reply to the interrogatories of the Royal College of Physicians relative to leprosy. The conclusions which Mr. Macnamara considers himself justified in drawing from these documents are the following: and so far as the data are concerned, they appear to us to be fully warranted. 1. That leprosy is a specific disease and confined to two forms, often mingled, the tuberculated and the anaesthetic. 2. That it is more or less generally diffused in the Bengal Presidency, in the Straits in Borneo, but is unknown amongst the native population of Burmah. 3. That it is decidedly hereditary. 4. That it is contagious, "but it is necessary for the propagation of the disease by this means that the discharge from a leprous sore should enter the blood of the healthy person; and, further, that the disease even then (unless under peculiar circumstances) may remain undeveloped in the system for years." In an in. teresting letter appended, facts are stated by Dr. Hillebrand, derived from his experience in Honolulu of the Sandwich. Islands, greatly in favour of this conclusion. In that island the disease, it would appear, has been known only for a few years; and that since its first appearance in 1852, it has spread so much that about 4 per cent. of the inhabitants are now the victims of it. 5. That neither climate, kinds of food, or filthy habits per se are capable of generating it. 6. That when fully formed it is incurable; but may be mitigated, at least, if not arrested in its early stage, more especially the premonitory. Mr. Macnamara states that from no application has he witnessed better effect than from the external use of Chaul Moogra oil. This reminds us that when in the Mauritius many years ago we heard of the temporary cure of the disease in cases of it removed to Tortoise Island, there employed in making cocoa-nut oil with which their bodies were smeared, their food principally turtle. Dr. Hillebrand remarks that he found nitrate of silver more beneficial in checking the malady than any other medicine of which he made trial; he began with one tenth of a grain, three times daily, gradually increased to a quarter and even half a grain, discontinuing it about the end of the third month. He states also that he had some good effects from copious draughts of cold water, six to eight tumblers daily. He Mr. Macnamara in a note to his paper, after adverting to the total deficiency of suitable hospitals and asylums for lepers in India, makes a strong appeal to the Indian government in behalf of the neglected state of the natives, so many of the vast population destitute, without poor-laws, without workhouses, or any charities from which their orphan children can receive relief. He urgently asks for a more liberal system, and apart from humanity asks for it on political grounds. points out how much might be done towards the acquiring a more exact knowledge of the epidemics which are the scourge of the country, were the highly educated medical officers of the establishment directed to investigate them, and encouraged so to do by the publication of the results of their researches ; and, in proof, he adduces the instance of what has been accomplished by these gentlemen in the short space of a few months as shown in their reports on leprosy. ART. VII.-Pavilion Asylums (with a ground plan.) By C. L. ROBERTSON, M.D. Cantab., Medical Superintendent of the Sussex Lunatic Asylum, &c. London, 1867, pp. 12. DR. ROBERTSON, in this paper, which was read at the Annual Meeting of the Medico-Psychological Association in Edinburgh |