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March 4th,-The patient suffered somewhat more ; but, in-stead of increasing the quantity of morphia, an injection wasadministered with sixteen drops of a solution of bromide ofpotassium. These injections were continued till March 8thwithout abating the pain, whilst they were followed by muchburning.

All local treatment was suspended until March 26th, duringwhich time the pains, though persistent, were more or less in-tense. At the end of this period, however, they increasedconsiderably; when, on an injection of thirty drops of thesolution being administered, the patient experienced notablerelief. The injections were then continued till the 12th ofApril, at which time symptoms of inflammation of the leftkidney became manifest.CASE 3.-A aged thirty-five, was admitted into the

wards on March 14th. Cystitis of one month’s duration.Fifty drops of the solution were immediately injected; and onthe very next day there was considerable abatement of thepain. Next, sixty drops were given on two separate occasions,with the same good effects.On the 21st (seven days after the patient’s admission) it

was stated that he passed water only four or five times duringthe night; whilst before his admission he was obliged to dis-charge urine every five minutes.

24th. —Thirty drops only were administered for the wholeday. The next day the patient said he had suffered muchmore than he did generally. It was decided that the samedose should be tried for a few days; but the pain became sointense that the full dose of thirty drops, twice a day, wasrecurred to with immediate relief to the patient.CASE 4.-A-, aged seventeen, was admitted into the hos-

pital on March 7th, with neuralgia of the left ovary. The dis-ease had manifested itself at the age of fifteen, simultaneouslywith menstruation, and had persisted since then, increasingin intensity at every menstrual period. The patient on everysuch occasion was compelled to lie in bed. She presented nosymptom of disease in connexion with the bladder. On thevery day she was admitted subcutaneous injections with chlor-hydrate of morphia were resorted to. The sensitiveness tothe remedy was so great that though only half a centigrammewas administered, it brought on vomiting. By degrees, how-ever, it became possible to inject half a centigramme twicein one day. The pain abated considerably. On the 12th themenstrual discharge appeared, and was attended by much lesssuffering than usual.On the 17th, M. Guyon bethought him of trying injections

of morphia into the bladder. Twenty milligrammes were ad-ministered twice the same day. This was attended by noaccident; and the relief which had been obtained by means ofthe subcutaneous injections persisted.22nd.-As the solution of morphia, composed of two milli-

grammes to a drop, was wanting, Mr. Alling thought he wouldgive a subcutaneous injection with half a centigramme of mor-phia, in order to afford some relief to the patient. The next

morning she, of her own accord, stated that she had decidedlynot derived the same relief from the subcutaneous injection asfrom the preceding injection into the bladder. The vesical

injections were therefore resumed. Twelve drops morning andevening were administered; and the patient declared that shefelt great relief as soon as the first injection had been given.From the 24th to the 31st of March there was no occurrence

worthy of being noted; but on the 1st of April, after the ad-ministration of the usual injection in the morning, the patientfelt symptoms of intoxication, which she spontaneously summedup thus : heaviness of the head; drowsiness; congestion of theface. This condition lasted for from five to six hours. It mustbe stated that on the eve she had taken forty-five drops ofmorphia; while her peculiar sensitiveness to the remedy abovementioned must be borne in mind.

April 2nd.-The injections were discontinued, and bromideof potassium was tried in their stead, but with no good result.The patient’s sufferings increased immediately; and in orderto continue the treatment it became necessary to employ,simultaneously, subcutaneous injections with morphia."I have not space enough," concludes Mr. Alling, "to dis-

cuss these details as I would like; but I shall endeavour tosum them up briefly. In the first place, the efficacy of in-jections into the bladder seems evident. We see in Case 1 thatthe pain speedily abated, that the desire to pass urine wasdiminished in a remarkable degree, and that sleep was restoredto the patient. In Case 2 relief was most speedy, since on thefourth day the patient declared that he had never felt suchcomfort for the last six months. In Case 3 the patient soon

experienced relief. Sleep was restored to him; for whereashe had been obliged previously to pass urine every five minutes,he was so much better that he discharged urine only four orfive times a night. I have had occasion in other cases to statea like amendment of the same symptom. But it is mostly withour fourth case that there would be need to insist upon the

particulars. Here the bladder was healthy, and M. Susini’sexperiments seem conclusive in favour of non-absorption insuch cases. How then are we to explain the persistent reliefderived from the employment of the injections, and the in-crease of pain, as soon as these were stopped ? With regard tothe occasion when symptoms of intoxication were experienced,it may be objected that there was some slight breach of themucous membrane. Obviously I cannot prove that this wasnot the case, though I am quite confident it was not. Beforeconcluding, I must note the fact that, in this last case, eachinjection was followed by a sensation of burning, which wassometimes very intense, and lasted for from five to ten minutes.I know not, however, what part this symptom may play inthe act of absorption, which seems evident to me in this case."

Reviews and Notices of Books.The Surgical Treatment of the -Diseases of Infancy and Child-

hood. By T. HOLMES, M.A. Cantab., Surgeon to the Hos-pital for Sick Children, Surgeon and Lecturer on Surgeryto St. George’s Hospital, &c. pp. 648. London: Longmansand Co. 1868.

IN this handsome volume the author has laboured very suc-

cessfully to bring together all the current literature bearingupon the diseases of childhood surgically considered, and hasillustrated his subject by his own experience acquired duringnine years’ surgeoncy to the Children’s Hospital. The rangeof subjects is necessarily a wide one, but we will endeavour toindicate. briefly the principal points which Mr. Holmes hasillustrated. Commencing with Malformations, the severalforms of congenital deformities are discussed in thirteen chap-ters, occupying 221 pages. Congenital tumours, cysts, nævus,malformations of the skull, spina bifida, hare-lip, extroversionof the bladder, imperforate anus, &c., are here all considered;but the author purposely omits club-foot and allied deformities,which are treated of in orthopædic works. The chapter onhare-lip is very elaborate, comprising as it does most of thosemodifications of the ordinary operation which have been pub-lished from time to time, but which we believe are seldomemployed. The question of operating on cleft palate at anearly age, as carried out by Bilroth and Mr. T. Smith, is dis-

cussed ; but the author does not bring forward any experienceof his own upon the subject. In treating of operations forextroversion of the bladder, Mr. Holmes describes those per-formed by Lloyd, Athol Johnson, and himself; but we aresurprised to find no allusion to Mr. John Wood’s cases, whichhave been numerous and successful, one being, we believe, ina female child. Mr. Holmes gives a good resume of the lite-rature of imperforate rectum; and we quite coincide with hisdirection to dissect in the perineum for the missing bowel,rather than to thrust a trocar and canula vaguely in searchof it.The second part of the work is occupied by a consideration

of the injuries to which childhood is specially liable; the sepa-ration of the epiphyses of long bones naturally receives at-tention, and Mr. Holmes does not appear to accept fully Prof.R. W. Smith’s views with regard to this accident as affectingthe lower end of the humerus. In the chapter on burns wewere surprised to find no mention of the intense shock whichchildren sustain, and of the necessity for directing attentionto this rather than to the local mischief. The maintenance ofthe vitality of the patient for the first few hours by warmthand stimulants is of far greater importance than the dressingof the wound. The author speaks of the advantage of pres-sure by strapping in the treatment of the exuberant granu-lations of burns, but does not seem to be aware of the great

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benefit the careful application of strapping to cicatrices alreadyformed may confer. The observations on tracheotomy, in thechapter relating to injuries of, and foreign bodies in, the wind-pipe, are valuable and to the point. Attention may be speciallydrawn to the sketches of the glottis at different ages at p. 325.The third part discusses the surgical diseases of childhood;

and the author, as might be anticipated from his previouswritings, dilates especially on the diseases of the bones andjoints. The question of excision or amputation is fairlyargued; and Mr. Holmes, while upholding the former opera-tion in appropriate cases, shows that in some instances even ofhip-disease amputation gives a more favourable result. We

may mention, as a surgical curiosity, that a case of excision ofboth elbows is recorded by the author. Diseases of the intestinaland genito-urinary tracts are next discussed. Mr. Holmes, likemost surgeons, prefers lateral lithotomy for children, unless,indeed, the calculus is so minute as to be crushed and broughtaway at one sitting. An engraving is given at p. 601 which,having been drawn on the wood by an amateur, represents theright instead of the left side of the pelvis with the parts con-cerned in lateral lithotomy. The sketch is, no doubt, accurateenough; but it is stated at three different places that it repre-sents the parts of ’’ the precise size of nature in a boy agedeight." This must be an error of expression; for, though re-lative proportion has no doubt been preserved, the drawing isconsiderably reduced in size. Mr. Holmes’s artist has notused him well in other instances : thus, at p. 114, the samenon-reversal of the drawing on the wood has necessitated amodification of the description of M. Giraldes’ operation; andat p. 617 is a drawing of an infantile hydrocele which is utterlyunintelligible. In addition to the woodcuts, however, thereare nine rlates of chromo-lithograph which illustrate verywell the subjects to which they apply.Taken altogether, the volume is a valuable contribution to

the literature of the subject on which it treats, and gives evi-dence of much research and accurate observation on the partof its author.

__ ______

P2-i2ici-oles of Forensic Medicine. By WILLIAM A. Guy, M.B.Cantab., F.R.S., F.R.C.P.; Professor of Forensic Medi-cine, King’s College, London ; Physician to King’s CollegeHospital, &c. Third Edition, Revised, Enlarged, andcopiously Illustrated by Wood Engravings. London :Renshaw. 1868.

WE need not say much in regard to this well-known book.Its general reputation is evidenced in the appearance of a thirdedition ; and its successive editions have this great excellence,that they are always up to the time in those fine points ofchemistry and physiology which have such important bearings onforensic medicine. This merit is very noticeable in the chapterson Mental Disease and the Detection of Poisons. Dr. Guyhas the credit of having suggested a method for procuringsublimates of the more important mineral poisons, especiallyarsenic and mercury, on a flat surface of gass, so as to admitof ready examination by the microscope. This edition has

quite a scientific value, as containing a good, if not the first,statement of the discovery of Helwig, of Mayence, that themethod of sublimation on flat surfaces admits of extension tothe alkaloids-a fact which greatly enlarges the power of che-mistry in the detection of some most important active prin-ciples, as strychnine, morphine, and cantharidine. It is im-

portant to record Dr. Guy’s opinion on the question of thedetection of strychnia :-

" Strychnia has now been detected in the contents of thealimentary canal, in the muscles and viscera, and in the bloodand urine. Messrs. Rodgers and Girdwood, also, state thatthey detected it in the bones. There is no longer any roomfor doubt that strychnia, like arsenic, antimony, and mercury,undergoes no change in the alimentary canal, in the vessels ofthe body, or in the secreting organs; but that it can be de-tected in organic fluids and tissues by a proper method of ana-lysis carefully and skilfully conducted." "

In leaving this book, which combines the conciseness of ahandbook with the authority of an original treatise, we shouldsay a word of great praise in behalf of the engravings in thisedition. They are very numerous and very admirable.

REPORTOF

The Lancet Sanitary CommissionON

THE STATE OF THE TOWN OF GUILDFORD.

Situation.-The town of Guildford is situated on the side ofa chalk hill, at a point where it is intersected by the river Wey.The larger portion of the houses are built directly on thechalk, but on the northern side a shallow layer of overlyingmarly sand and gravel is interposed.

’ Drainage.-Of this there is, scientifically speaking, none,if we except a partial system of surface drains, which dischargesonly a very small proportion of slops and sewage into theriver Wey. In the words of Dr. Buchanan, ’’ the chalk fur-nishes a perfect natural drainage," and this statement is quotedby the local authorities apparently in justification of the exist-ing arrangements. Cesspools are made in the rear of nearlyevery house, and into these the sewage is discharged. The

liquid parts pass off rapidly through the porous chalk, whilstthe solids accumulate, and are for the most part removed atintervals of years. These cesspools are therefore extremelynumerous. In the denser portions of the town they occur atintervals of a few yards only; and they are so close to thewells that a direct communication has occasionally been made.We saw one well five yards only from the nearest cesspool,and there were five or six within a radius of fifty yards ;and another, in a yard upon the Mount, was sixteen yardsfrom a cesspool which received the sewage of five privies, twopiggeries, and seven houses. In this yard there was also asuperficial drain, the grating of which is only eighteen inchesfrom the margin of the open well from which the supply ofwater is derived. It was stated by the inhabitants that thisgrating is easily choked up, and that the liquid then runsdirectly into the well. It is therefore certain that the wellsof Guildford are exposed to the danger of sewage contamina-tion, and that the larger the supply of water the more likelyis this to occur. ’

There is distinct evidence that very many of the cesspoolshave never required cleansing even for fifty years, although thesewage of large families has been regularly discharged into them.Ordinarily, they require the removal of accumulated solidmatter every three or four years; but now and then, whenpersons have opened their cesspools with the expectation offinding them choke-full, they have been astonished to dis-cover them dry and almost empty. This occurred in High-street. A cesspool into which the drain of a watercloset usedhabitually by a large family was turned, and which also hasreceived the slops of the house for more than forty years, wasopened with the view of cleansing it. It was only eight feetsquare, and was found to contain so small a quantity of solidmatter (only some inches) that it was closed up without furtherexploration. This fact appeared so important that no painswere spared to ascertain its truth. It proves that there are insome situations channels or faults in the chalk through whicheven solid matters may be conveyed. In the case before us,either the solid matters have so passed off, or, as would seemmore probable, the cesspool communicates with the system ofsprings by means of such a fault or channel, and it is flushedout from time to time in wet weather, when the water is ex-tremely high.But this is not all. Since the introduction of the public

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