advertising pamphlets, and in the paraphernalia generally of quackery. It seems, indeed, a difficult task for the professional and professedly philosophical describer of any particular watering-place to confine himself to the simple narration of facts. The invigorating air and health-restoring waters act as stimulants on the brain, and the cerebral tension discharges itself by the imagination; and in general the professed medical exposition of the characteristics of the climate and waters resolves itself into an undiscriminating eulogy on the locality, profitless to the serious inquirer into its real merits.

There is likewise a loose, unphilosophical way of referring to diseases to be cured by the waters of each spa. A whole series of maladies are strung together, and it is made to appear that the same routine of eating, taking exercise, drinking the waters, and bathing in them, is equally beneficial in one and all of them. A process is prescribed which is to be gone through with, like the requisite details of a charm. The mineral spring is a Fetish, to be worshipped according to set rules in well-nigh whatever malady torments the devotee. Disease is a something duly ticketed with a name, and so treated as an unvarying entity; complications, constitutional peculiarities, and diathesis counting for little or nothing, until, by their rebellion to the routinism, they disappoint the hopes of the patient, and drive the water-doctor to rash expedients or to equally rash explanations of failure.

Another defect in the literature of health-resorts is, that the majority of works on such places are written as much, if not more, for the public than for the profession. This being so, the endeavour is to make them pleasing and attractive; and hence the calm, philosophic investigation of their climatology and of the maladies for which their air and waters appear salutary is sacrificed to a superficial and flattering account of their many virtues and natural beauties. Moreover, as by this state of things the public verdict is sought in the selection of a healthresort, it is not surprising that medical opinion is often not asked, or, if asked, slighted; or that medical men often pursue a laissez-faire policy with many of their patients intent on trying some fashionable or well-advertised wonder-working spa.

Apart from these prevalent faults in the descriptions of watering-places, and the consequent impediments to ascertaining the precise operation and value of their waters in various diseases, a medical man, as before remarked, is embarrassed by the number of resorts possessing, in respect to their general chemical compo sition, similar waters. He has, indeed, accomplished a considerable task when he has acquainted himself with the geographical position and the general chemical constitution of the leading

spas of Europe. Those who have not attained this knowledge will find great assistance from Dr. Macpherson's work on The Baths and Wells of Europe.' That author has brought together in a very small compass a notice of the principal spas of this country and of the Continent, and by means of an index of the towns mentioned the reader can refer to it as to a dictionary for an account of the leading characters of the springs. In the case of several of the more renowned spas he gives a succinct history, not only of their chemical characters, but also of their mode of administration and uses. Dr. Edwin Lee has more fully detailed these particulars with respect to the Baths of Rhenish Germany,' and has given sundry other information of general interest touching their climate, local features, and accommodation for visitors. The source of most of Dr. Lee's information is from local historians, and consequently allowance must be made for a prevailing couleur de rose.

The article on the therapeutics of mineral waters in the 'Nouveau Dictionnaire de Médecine et de Chirurgie,' by Dr. Verjon, is very brief considering the largeness of the subject, and chiefly concerned with the mineral sources of France. The general remarks on the applications of the several classes of Inineral waters are good; and an appended table of the chronic diseases for which such waters are recommended, and of the principal stations appropriate to those diseases, is very useful by the manner in which it at once brings under the eye that most important amount of information.

The brochure on the mineral waters of Contrexéville, a village in the Vosges, made famous by the battle fought around it during the recent terrible conflict between France and Prussia, is written by the local medical inspector, and, as a matter of course, partakes of the character attaching to the literary productions of local doctors, who consider themselves as holding a retainer for the advocacy of a place and an interest. The principal source belongs to the alkaline group of mineral waters, rich in soda and lime salts. A recent analyst has also discovered lithia in extremely minute proportion. Marvels are recounted of their operation in the cure of gravel, stone, and vesical catarrh.

Nothing like an analytical critique can be made of Dr. Meyer-Ahren's bulky Treatise on the Mineral Springs and Health-Resorts of Switzerland,' without a proportionate amount of space. The treatise exhibits what may be done by a patient, plodding writer who desires to make his work an exhaustive one. The book is a complete mine of information, and enterprising book-makers may freely borrow from it without fear of detection. The whole, true, full, and particular account of each

place that pretends to be of hygienic value is given, and, in several instances, an effective pictorial illustration is added. We are gratified to bear witness to the completeness of the treatise and to the amount of learning and of patient inquiry it contains, and also to find that it has been so appreciated by his countrymen and others as to have reached a second edition, a circumstance which, if it occurred in England in connexion with a similar publication, would rank among the marvels of literature. There is much useful and fairly precise information conveyed in Dr. Williams's small treatise, which is likewise less occupied with extraneous matter than the work of Dr. Bennet, and, unlike this, intended rather for the library of the medical man than for the drawing-room. Dr. Williams also has briefly dealt with the special subject of Dr. Yeo's book, viz. that of the worth of mountain stations for invalids, a question that merits further inquiry and separate discussion.

V.-Lee's Surgical Pathology.1

IN the literature of the medical profession it would be difficult to overlook or under-estimate the value of the numerous contributions made by the author of these lectures to the pathology of the various blood-poisons and of the lower bowel.

The views embodied in these contributions have been put forward at various times in a more or less detached form, so as to make them familiar to every member of the profession who has the slightest pretension to rise to the level of his professional brethren. To those who have not up to the present time attained to that decent altitude, the work before us offers an opportunity which should not be neglected to repair that deficiency.

In two considerable volumes, printed in a type considerate in its conspicuousness, each volume preceded by a table of contents which is full enough to be short notes of the subjectmatter, suggestive enough to give a hasty, hurried, or superficial reader a fair sketch of the ideas of the author without the trouble of reading through the book, we have a résumé of Mr. Lee's well-known opinions upon those points of surgical pathology which he has made peculiarly his own.

The first volume (containing nineteen lectures) deals with the important subjects of Purulent Infection, Phlebitis, Varicose Veins, Embolism; the common diseases of the Rectum, such as

1 Lectures on some Subjects connected with Practical Pathology and Surgery. By HENRY LEE, F R.C.S., Surgeon to St. George's Hospital, Hon. Fell. King's College, London.

Piles, Fistula, Stricture, Spasm of Sphincter, and malignant disease, together with the operations, including those for the relief of lacerations and congenital malformations. Abscess of Bone and Excision of Joints form the subjects of the two last lectures.

The second volume is devoted entirely to the great subject of Mr. Lee's persevering observations and most valuable contributions, viz. Syphilis and other Venereal diseases, with a concluding lecture on Albuminuria after surgical operations.

In the first lecture, on Purulent infection, the author combats Cruveilhier's theory of primary and secondary phlebitis, and refers to his own observations, that the lining membranes of veins do not become inflamed so readily as other serous membranes. He supports the theory maintained by Virchow, that the morbid phenomena start with changes in the centre rather than at the periphery of the coagulum which first blocks up the veins. The author throughout is careful to speak of these changes as resulting in the formation of purulent-looking deposits, whence we infer that he is not prepared to maintain that they contain real purulent matter or pus-cells; but, on the other hand, he states that the cells which resemble pus-cells are the cellular constituents of the fibrin of the blood-clot, such as white blood-corpuscles, shrivelled red corpuscles, and molecular débris, such as may be found in a piece of dead fibrin removed from the body, and subjected for a while to a temperature of 100°, as shown by Professor Gulliver. He states that, though the internal coat of veins is not very subject to ordinary inflammation, yet that it may be affected by a perverted nutrition allied to a state of inflammation, and so may lead to a coagulation of the blood within, in the way described by Professor Lister.

It is, perhaps, difficult for the reader to judge precisely from this statement what the definite opinion of the author may be upon this last important point, to which his researches, published in the Medico-Chirurgical Transactions' for 1852, vol. xxv, were especially directed to. In the work before us he certainly states explicitly (p. 18) that real phlebitis undoubtedly occurs, sometimes as a consequence of injury or external irritation, as in piles, and so becomes the cause of the formation of a clot, and sometimes as a consequence of some irritating matters introduced into the blood. Such matters, he believes, may, in the first place, either cause its coagulation, or, in the second, produce its decomposition (p. 24). In all cases in which layers of fibrin are formed upon the walls of the vein he considers them to be derived from the blood contained within its cavity, and not from that circulating in its walls. Upon this point, however, it can hardly be said that the proof lies in the record before us; and it is more than probable that in the veins, as in

the arteries, the substance that seals up the tube permanently is derived from both sources.

The interesting experiments of M. Gaspard cited in this lecture, as well as the experiment performed for the author himself, prove clearly that the injection of putrid matter into the living blood-vessels sets up inflammation of the whole alimentary and respiratory mucous membrane, and explain the occurrence of diarrhoea and pneumonia in cases of septic blood-poisoning. This is, no doubt, evidence of an attempt at excreting the poison through these channels.

gan

The occurrence of limited and circumscribed patches of grene in some of these cases is attributed to the blocking up of the smaller radicles of the arteries supplying the part, by embolism. In the section on the treatment of phlebitis the author gives an interesting case in which a festering sore on the index finger was followed by spreading phlebitis along the vein, which the author describes, somewhat regardless of the ordinary anatomical nomenclature, as the basilic vein in the forearm. Under this vein (which we suppose to have been that which is described in the standard works of anatomy as the radial vein, since it is that which leads from the index finger) two needles were placed, and the vessel was divided between them. The result was a stoppage of the inflammation at the point operated on, and the formation of two abscesses, one on the so-called basilic vein in the forearm, but whether these occurred at the place operated on or no (a point of some importance) is not mentioned. In a second case, of bursting of a varicose saphena vein in the thigh, succeeded by spreading phlebitis, a similar course was pursued, also resulting in the formation of two abscesses, one of which was placed above the point operated on. In the same case a previous operation to arrest the bleeding by acupressure resulted in the puncture of the vein itself by one of the needles. A similar mishap occurred in the case next recorded (p. 65), in which the operation by two needles, with intervening section of the vein, was done for varicose saphena; this was followed by rigors and phlebitis, which were treated by a more successful application of a single needle higher up the thigh, without subcutaneous division. A fourth case of phlebitis of the basilic (?) in the forearm, this time on the inner side, was equally successfully treated by a simple pad placed upon the vessel immediately above the inflamed part.

The deduction drawn by the author from these cases is scarcely made evident to the reader by the description given, viz. that a preference should be accorded in such cases to the operation of double acupressure, with division of the vein between. It very commonly happens, indeed, that the progress of