63

ing day the toxical effects of the drug had passed off, and thechildren were perfectly well.To adults the author administered the drug in pills and in I

solution, and he found that, however given, very small dosesusually produce dryness of the tongue and fauces ; that twograins daily will often excite vertigo and dizziness, and that itis not possible to establish a tolerance of the larger doses as inchildren.He was thus led to the conclusion that-1st.—The tolerance of belladonna is not attributable to the

counteracting influence of choreic spasms, but is in some wayconnected with the age of the patient.2ndly.-That a much larger dose than is usually prescribed

is well borne from the first by children of tender years. ’

3rdly.—That in children, though not so in adults, a toleranceof the remedy is speedily established, so that the dose may besafely increased, rapidly, but gradually.4thly.-That special care should be taken in apportioning

the dose to the age of the patient, and in not increasing thedose too rapidly, inasmuch as the usual toxical effects of thedrug will be produced if too large a dose be given before asufficient tolerance of the drug has been established.5thly.-That the milder toxical effects produced by the drug

are of little importance, and subside without remedies as soonas the administration of the medicine is discontinued.

6thly.-That adults cannot tolerate the doses of the drugwhich can be taken with impunity by children.The extraordinary difference in the tolerance of the drug

observed at different periods of life, the author remarks, maybe explicable by the medicine passing off with the urine, asalso, probably, with the other excretions, more rapidly inchildhood than in adult life; and he concludes his paper by thefollowing suggestions:-

1st.—That inasmuch as belladonna is admitted to be pro-ductive of signal benefit in hooping-cough, even in the minutedoses in which it has been hitherto administered, it is probablethat a corresponding increase of benefit would result from thelarger doses, which it is now proved may be safely prescribedunder certain restrictions.

2ndly.—That it deserves a trial in epilepsy, larynzismusstridulus, and other spasmodic affections.3rdly.-That combining as it does antispasmodic, sedative,

and slightly purgative properties, it may be productive of reliefin certain cases of dyspepsia connected with infra-mammarypain, flatus, and spasms in the abdomen.4thly.-That inasmuch as it exercises a remarkable power in

controlling spermatorrhoea and incontinence of urine, and theexperiments recorded in this paper prove that it is excretedwith the urine, it is highly probable that its curative action insuch cases may be due in great measure to its topical effect,and if so, that it might be applied locally with advantage.

Reviews and Notices of Books.On the Operation for Strangulated Hernia. By J. H. JAMES,

F.R.C.S., Consulting Surgeon to, and late Senior Surgeonof, the Devon and Exeter Hospital. 8vo. London:Churchill.THE author of this excellent little book offers as his apology

for appearing before the public the fact that his remarks arepurely practical. They are the result of several years’ expe-rience and careful observation. Mr. James does not profess towrite a treatise on hernia, but, as he says, " the object is asbriefly as possible to give the result of my own experience,either as confirmatory of some, or as opposed to other, pointsof practice which may be now more or less in esteem; givingreasons for my opinions when they differ from those of others,and offering in some instances views which I believe to benew. "

Mr. James arranges his cases in three tables (those used byMr. South): the first containing all the recoveries; the second,the fatal cases in private practice; the third, those which oc-curred in the hospital. The advantage gained by this plan isevident.

After a few practical remarks concerning the mortality ofhernia in reference to age, sex, &c., Mr. James concludes that,as a general rule, the danger seems to be in an inverse ratio as

respects the lapse of time. We think the author intended tohave said, in direct ratio. This is one of the mistakes incurred

by using language extraneous to medicine. The chief fault tobe found with this otherwise valuable addition to its specialdepartment of surgery, is the ambiguity of some of its phrase-ology.Mr. James mentions an additional source of diagnosis of in-

guinal hernia in the female-one which we do not rememberto have seen described before :-’ "If the hernia be true inguinal, it must of course comethrough the inner ring and take the usual course into the groinand labium; but in such cases as these the cause of obscurityis that the tumour mounts nearly to the spine of the ilium."

The author then passes in review the various methods for

relieving strangulated hernia-the warm bath, chloroform,O’Beirn’s long tube, traction from within, &c. He places littleor no faith in topical remedies. The operation itself is thendescribed with great minuteness, from the appearance of thesurface of the scrotum to the description of the fluid containedwithin the sac. From the external appearance of the scrotumMr. James draws certain inferences, and from these appear-

ances predicates the state of the investments beneath. These

and other remarks upon the pathology of the contents areexcellent. The second stage (the first is the division of the

investments), or division of the stricture, then receives consider-able attention. His remarks apply principally t femoralhernia. In the twenty cases upon which he operated, he foundthe stricture to correspond with the edge of Gimbernat’s liga-ment. He objects, and we think very correctly, to the use ofa director in dividing the stricture; suggesting that, as thereis intestine above as well as below the stricture, and thatgenerally much distended with flatus, it will be exposed tomischief from not being sufficiently guarded against by thedirector and knife as commonly used. Mr. James divides thestricture in this way :-

" Having insinuated the very point of my finger, I pass anarrow, strong, probe-pointed bistoury, guarcied very nearlyto the end, taking care that its edge is sharp. Passing thiswith its flat side, as soon as I have got its extremity into theedge of the stricture I turn it, press its back into the pulp ofmy finger, press the point of that, so ceewaed, against the edge ofthe stricture, ca efully avoiding any sawing motion, but cut asit were with the 1inger itself."We know of no better method than this to divide the stric-

ture, and have long been persuaded that in relieving a hernia.by operation the forefinger is the best possible director we canhave. As to the extent to which the stricture is to be divided,Mr. James recommends that, if necessary, we should not beafraid of making too large an incision.Mr. James believes that there is active constriction by the

ring. He says-" It is said the ring itself is not muscular, therefore it cannot

contract; but do not parts contract which are not muscular?A name often blinds us to facts. We have been long accus-tomed to connect contractile power with muscular structure :but let us take another case of strangulation-that of the glanspenis in paraphymosis; the stricture here is undoubtedlycaused by common integuments. (I may mention two colla-teral but more doubtful arguments in favour of the opinionthat the constriction is active : first, the great difference be-tween the feel of the edge in the dead subject and in hernia;and, secondly, the great difference in the degree of constric-tion.) If it be said that it is, both in this and in hernia,merely a cord bound round, and that tile ei1’ects are owing tothe engorgement of the glans, the answer is, that, empty theglans as you will, either by cold or pressure, it will still befound, in most cases, that you cannot reduce it; but if thepatient is rendered faint, it can be returned, just as in hernia;or, that failing, the stricture must be divided, as in. tbatmalady. What applies to the one case, I apprehend, mayfairly be applied to the other; and faintness serves both inhernia and paraphymosis."We perfectly agree with the author in these opinions, so

well expressed ; and although there are manv very high

64

authorities who have contended that no constriction can take 12, Royal-terrace, Weymouth, July lst, 1859.

place from contraction of the ring, we do not see how such MY LORDS AND GENTLEMEN,—I beg most respectfully to callremedies as opium, chloroform, tobacco, &c., can operate, your attention to the complaints of the Poor-law medical offi.unless there is some spasmodic action to be overcome. In cers, with the hope that you will immediately take their case

.... into your serious consideration. A full account of theircases of tapping either abdomen or hydrocele, the resistance grievances will be found in the accompanying pamphlets; andmade to the withdrawal of the canula by the clipping of the in No. 3, pages 30 and 32, is the following statement of theskin must be familiar to every surgeon. Mr. James, justly, Right Hon. T. Sotheron Estcourt, the then President of yourdoes not recommend the use of purgatives, and says, when the honourable Board :-

action of the intestine is antiperistaltic, opium by the mouth " Looking at the question practically, I think we have made- some progress. Last May, there was almost a doubt as towill often reverse it; still more when given as an enema; and whether there was a grievance, but now the existence of the

not only in strangulated hernia, but in ileus, and other inflam- grievance is admitted. What I hope to do is, in the course ofmatory conditions of the bowel. the present session, to prepare a Bill (if we can arrive at a

Mr. James passes in review the causes of death. In the solution of the difficulty), lay it on the table of the House......majority of cases it is peritonitis, sometimes combined with It may then be printed and circulated in the shape of a Bill

.... towards the end of the session; and if it is duly consideredenteritis, and he makes distinctions between the peritonitis during the recess, there will, next session, be no difficulty insupervening upon hernia, and ordinary idiopathic peritonitis. carrying it .....The matter ought not to continue in its present

After a systematic arrangement of all his cases in tables state; and if I continue in office, I shall use the best means insimilar to those adopted by Mr. South, the author compares my power to put the question on a better footing, and to makethe method of operating by opening the sac with that proposed

such arrangements as will be satisfactory both to you and the

by Petit and others; and gives reasons for supposing that The above quotation will enable your honourable Board tomost strenuous advocates of Petit’s operation have scarcely understand the position of the question whilst in the hands oftaken a complete and unbiassed view of the principles on which your predecessors; and as the army and navy medical depart.the success of either method may depend. ments have been placed upon a more equitable footing by

In a concluding summary, Mr. James gives a brief capitula- orders of her Majesty’s Government, I earnestly hope that

tion of the contents of his book, and draws certain deductions have annually the treatment of more than a million and aof a very interesting and practical nature. quarter of the sick poor of England and Wales, will have theirWe can confidently recommend this little work to those grievances removed, and their services so requited, that they

persons who wish to be au courant with the best principles may be enabled to do their duty to the poor without feelingand practice of their profession. that, as is the case in too many instances at present, the paltry’’

’

pittance accorded to them by the Guardians* does not pay for

The T2-eatg)ze)?t of Obstinate Ulcers ancl Cutaneous Eruptions value of the time and talents devoted to a service which is

The Treatment of Obstinate Ulcers and Cutaneous Eruptions therefore ought to be remunerated in an equitableon the Leg v-7itliout Confinement. By HENRY T. CHAPMAN, public, and therefore ought to be remunerated in an equitableF.R.C.S., &c. &c. Third Edition. pp. 161. London: In the accompanying pamphlets will be found almost all thatChurchill.

can be stated on the subject, but should your honourable BoardIN announcing the third edition of Mr. Chapman’s useful desire to make further inquiries of your medical officers, and

little essay, we may endorse the statement of the author, that wili name a day for a deputation to wait upon you, I will callhe has

, a meeting for that purpose; or at any time I will attend per-

"Endeavoured to render .... sonally, to answer queries, or to assist in preparing measures

"Endeavoured to render it as complete an exhibition as for a reasonable adjustment of the question.possible of the practice advocated, without increasing its bulk. Once again I pray your honoura’ole Board will take up ourWhatever additional matter has been introduced is concisely cause without delay, and carry out the promises made by yourwoven with the former text; and where new cases are admit- honourable predecessors when in office; and that you will care-ted, they merely occupy the place of others which have been fully remodel a system which is cruel in the extreme to verywithdrawn to make room for them....... In the present many of your officers, and, I greatly fear, is also injurious toedition is incorporated a series of papers on the local treatment the welfare of the sick poor.

’

of ulcers....... A section has also been added on the manage- I have the honour to be, my Lords and Gentlemen,ment of erythematous, eczematous, and other cutaneous erup- Your obedient servant,tions upon the lower extremity." RiCHARD GRIFFIN.

,-.,,, , . court, on quitting the office of President of the Poor-law Board,

The Pathology of Tuberculous Bone. By CORNELIUS BLACK, explains the intentions of your immediate predecessors.M. D. Lond., &c. &c. pp. 40. Edinburgh: Sutherland and p J i.

4th March, 1859.’ , , ., .

DEAR SIR,—I assure you that it is a matter of regret to me1ms tract contains a considerable amount of pathologic in- that I should be transplanted to a new office, from one whereformation in a small compass. We are entirely opposed, how- I had gradually become exceedingly interested in the manage-ever, to the use of such a phrase as that of "the stage of ment, and where I was engaged in watching the progress ofgermination," as applied to the progressive metamorphosis of certain proposed improvements, and hoped to have been per-tuberculous matter. IV, e feel also inclined to demur to the mitted to bring them to maturity; amongst those, I need not

infallibility of certain cases adduced as illustrative of a some- relief holds a chief place, and I am anxious to lose no time inwhat obscure morbid state, where the tissues have not come informing you, and through you the gentlemen with whom youunder either the scalpel or the microscope of the pathological are associated in this matter, that my successor, Lord March,inquirer. expresses to me a wish to identify himself with me in the.

...,....,...........—..... ., course which I have hitherto followed in this business; that itwill not be necessary to reproduce before him the papers and

POOR-LAW MEDICAL REFORM ASSOCIATION. documents, or to restate the arguments which you have already. furnished to me; and that he will at as early a period as other

To the Editor of THE LANCET. business will allow attentively consider the bearings of theSIR,—I shad feel obliged by your giving insertion to the question with a view to a practical measure.

following letter, in order that the Poor-law medical officers I am, dear Sir, yours very truly,following letter, in order that the Poor-law medical officers R Griffin, Esq., Weymouth. T. SOTHERON ESTCOURT.

may perceive that their cause, though in abeyance for a time, R. Griffin, Esq., Weymouth. T. SOTAERON ESTCOURT.

in consequence of the ministerial changes, has not been for- Seventy-nine medical officers receive less than Is. per patient they attend,gotten by me.

° and 806 less than 3s. per case, though the duration of illness averages 22 days.

I am, Sir, &c., COLLEGE OF DENTISTS.—Mr. Waite has been electedRoyal-terrace, Weymouth, July, 1859. RICHARD GRIFFIN. President of the College of Dentists.