"I cannot forego the pleasure of bearing testimony to the excellence of the book, which is in many respects superior to any yet published on this side of the water. Some of the views advanced in reference to the processes involved in inflammation, as well as the reasoning based upon them, have the merit of originality. Whatever else may be said of them, it cannot be denied that they are very ingenious. The careful reader cannot fail to be impressed with the conviction that the author of the work is a profound student and a close observer. His love of the subject, as evinced in the enthusiasm which glows on almost every page, gives promise that in succeeding editions he will supply what is wanting, and thus render year by year the work more and more complete and valuable."

But I fear I have encroached too much upon your space. I must say that I felt a great unwillingness to thus obtrude my own work upon your attention. I trust, however, that the reasons given above will be deemed sufficient. I repeat I do not complain of your notice of my work, for it is written in the kindest spirit, and has bestowed no little credit. I only desire to indicate, what was no doubt an oversight, wherein there is, according to my own knowledge of surgical writers, to be found something original.

Belleville, 26th November, 1866.

REVIEWS AND NOTICES OF BOOKS.

W. C.

Orthopedics: A Systematic Treatise upon the Prevention and Correc tion of Deformities. By DAVID PRINCE, M.D., 8vo. pp. 240, Philadelphia Lindsay and Blakiston, 1866.

(Continued from page 201.)

The author discusses in the third section of the work the pathology and treatment of articular diseases. The forty-four pages devoted to the subject might have sufficed for a thoroughly competent pen to give a brief and comprehensive digest of this very interesting topic. But the author is obviously not at home in this matter, and has certaily failed to redeem his pledge (perforce) to render "the advance in knowledge on this subject, gained within the last twenty years, accessible to the mass of the profession." In fact, this section is made up of quotations from Barwell's treatise "On the Joints," in the style of Braithwaite's Retrospect, with a few insignificant comments. This is certainly a very commodious way of book-writing, though of questionable literary value, and

hardly commendable for imitation. However, our author is of but modest pretensions, and a comparative novice in the arena of science; we must, therefore, look with leniency upon his first literary effort. Nevertheless, we believe that a candid and well sustained criticism is not only compatible with kind intentions, but even preferable to the sloppy and stereotyped literary notices in which some journals indulge, and which they keep on hand for the most contemptible products of the pen.

We are not surprised to find the author kneeling at the shrine of that pathological chameleon, otherwise known by the appellation of strumous disease. Neither he, nor his fountain-head, show any disposition to define that malady, or furnish reliable anatomical details for differential diagnosis. They simply take it for granted that there is such a disease old enough to be known and understood by every reader of their respective works. We must forego the pleasure of discussing this point at length. In order to let the author know that the question of the existence of strumous disease is not as yet settled beyond dispute, we beg to remark that no less an authority than Virchow denies it in toto; the modern ophthalmologists have expelled scrofulosis from their precinct; and Louis Bauer has disputed the strumous congestion of joint diseases. The author may not choose to accept of their opinions, but then he should say so, and disprove their arguments and clinical facts. Το ignore them may be convenient, but it exposes the author to the charge of ignorance or temerity in grappling with them. Withal it seems that Dr. Prince has not a very serious apprehension of that deas ex machina, when he pronounces (page 49) the indications for treatment very similar with those inflammatory diseases that arise from wounds and injuries of the joints. And, indeed, the treatment adopted by the author, and commended to the reader, precludes the supposition of constitutional causation at all.

The pathological details do not invite close analysis, for they are but fragmentary and ill-digested. Thus, for instance, he favours the opinion that the synovial membrane is the most susceptible structure of the articular components, notwithstanding that they are deprived of nerves and vessels; and to the bones, and especially to the epiphyses, though so richly endowed with them, he allowed, as it were, a back seat. The description of strumous synovitis borrowed from Barwell is so general as to apply to any joint disease, traumatic or constitutional. Next it is self-evident that violence must expend its force much more upon the bones than upon a yielding membrane protected by integuments and fat. However, we cannot bring to bear upon the author's views a more

elaborate criticism, space prohibiting, and must defer doing so to another occasion.

About the treatment of this class of diseases we have to say but little. The author has certainly and most diligently compiled nearly all that is known, without being complete or in every respect comprehensive. Nevertheless, we feel grateful for many historical notes.

Like other good surgeons, the author insists upon absolute rest of an affected joint, omitting, however, to indicate the proper means to achieve it. In the beginning of these diseases rest alone is sufficient to prevent the advance. He deems recumbent posture and extension the best, Neither insures rest. The former removes the weight from the joint; the latter elongates the muscles, and prevents spasms and contractions. With both the patient can move the joint. The simplest and cheapest way to procure rest in a certain position is a firm bandage around the joint, extending to the next articulation, and thoroughly impregnated with dextrine, plaster of Paris, or silicate of potash, the last being in favour with the school of Vienna. In some joints splints of leather and sheet iron may be substituted. In incipient hip-disease, the "wire breeches," introduced by Louis Bauer, secure complete rest, and proper position of the affected extremity. These important improvements in modern surgery, Dr. Prince has partly underrated, partly ignored. Extension is to be resorted to when spastic oscillation commences; but the ordinary method of applying it by means of adhesive strips, pulleys, and weights, is certainly inefficient, because it enables the patient to accommodate himself to the traction. We have to avail ourselves of a fixed point. The perineal strap does not answer the purpose. One apparatus, which keeps the pelvis in a steady positition, is the mode in. dispensable when the muscles have already commenced to retract; and the author would certainly have insisted upon its use, had he acquired an extensive experience in the treatment of this class of diseases. We must take issue with the author on the efficacy of extension in muscular contractions. In a few cases of forcible, a persistent gradual extension may suffice to overcome the organic resistence of contracted muscles, but it mostly fails. Experience has decided this fact. The division of the resting structures becomes then indispensable. The author has utterly failed to appreciate the therapeutical action of myotomy and tenotomy. They not only annihilate resistance, and thus facilitate a proper position of the joint, but they act as a powerful antiphlogistic, contributing more to the arrest of the disease than the balance of remedies in vogue. We have practised both extension and division long enough to have an opinion on the relative efficacy of either.

A great advancement was wought by the introduction of portative extension inasmuch as it enables the patient to enjoy the desirable open air exercises. And Dr. Davis is entitled to the full share of credit for this improvement. There remains, however, a vast field for mechanical perfection of those portative apparatus heretofore in use. When Davis's splint became known, the profession was in ecstasy, and indeed it has a conditional value. Experience has however decided that it cannot cope with aggravated cases of hip diseases, cannot render dispensable the use of the knife, nor prevent the progress of the disease. The same objections apply to Sayre's, Barwell's, or Vedder's respective splints. Dr. Andrew's pelvic crutch is evidently an improvement in the right direction. We are truly glad to have seen it. Sayre has lately published the like apparatus for the knee, and ankle joints. They are both ingenious and effective, and should have found a place among the numerous illustrations of less value in this work.

In effusions of the joints, the author thinks that the use of the trochar would do no harm. We think it will, unless the joint is properly prepared for the puncture, or such movements are made with the joint as to favor the exit of the liquid, and prevent the entrance of air. Barwell has informed the author to whom surgery is indebted for this operation, but the author thinks so little of it as to mention it merely in passing.

The author is still inclined to favour counter-irritation, and doubts that remedies of which our professional ancestors thought so much, should have become entirely worthless to the present generation. The same logic applies to indiscriminate bleeding, and yet it has been almost entirely abandoned for very relevant reasons. Dr. Prince may tell a nice little story of a boy who submitted to the hot iron, under the promise of being taken to the theatre, but it proves very little to the point. Counter-irritation has been indeed thoroughly tried and assuredly too much so for the good of the respective patients. But having disappointed the expectations of both surgeon and patient, and rather aggravated the suffering of the latter, it has been given up by the wiser portion of the profession. We have seen cases in which the fly-blister instantaneously produced spastic contraction, in diseases of the knee and elbow joints. The author may not have had the same opportunities, but then he is disqualified for counselling others on this point.

On page 58, the author commends the bold and free incisions of the late Dr. E. S. Cooper "to give free outlet to the offending fluid in violent inflammations," and on page 61, he is inclined to the advice of South who thinks it preferable not to meddle with abscesses of the hip joint !" Every sound surgeon will follow the contrary maxim. That is to say, he

may be forced to relieve an inflamed joint of its effused material by puncture, but articular abscesses by free incisions, for reasons which require no further proof.

His patient, a

striking upon "This is the only

The 4th division on lateral curvature of the spine, is so flippantly compiled as to be rendered useless in every particular. The subject is yet, involved in some obscurity, but Dr. Prince renders it still more obscure. Lorinser of Vienna is the only author who ascribes lateral curvature to morbid changes of the spine, and its ligamentous apparatus; whereas the greatest pathologists, including Rokitansky, emphatically deny it, nor is the opinion of Lorinser borne out by facts. Yet our author enumerates under II, as one of the common causes, and links it with violence to the spine in general. The case by which he attempts to substantiate his opinion on page 125, is certainly a most singular one. lad of 15 years, fell from a house, three years previously, his head and was nearly helpless for a few days after. known cause" of the deformity that occupied the superior half of the spine. The author informs us that after ten days' use of his apparatus delineated on page 107," the patient had increased half an inch,” after two months 1 inch; and after five months 11⁄2 inch; and he thinks he might have gained still more if he had kept the patient in the horizontal posture. A competent reader might feel inclined to take the whole, as an opportune story and might apply the remark of Solly; that but "knaves and ignoramuses" could assert the straightening of a curved spine tantamount with the increase of height; but we do not choose to deal so uncharitably with Dr. Prince as to question his veracity, though we cannot save his diagnosis of" softening of the spine." The only commentary we have to offer is, that the patient, in consequence of the violence sustained, suffered from local paralysis of the muscles concerned in the deformity, and that the doctor succeeded in re-establishing the proper innervation, for his apparatus is too ineffective to bring about the claimed result.

Under II. Dr. Prince enumerates spasmodic contraction of dorsal muscles as another of the causes of lateral curvature. This opinion has been started by Jules Guein, but Malgaigne, has so thoroughly exploded it as utterly groundless, that we are rather surprised to find the author still possessed of it. It is well known, and should not have escaped his notice, that the former extensively practised myotomy upon the supposed contracted dorsal muscles, and had the coolness to promise to the French Academy of Sciences ocular demonstrations by his patients he pretended to have restored to their normal form and height; but unfortunately his patients, on examination by a committee, proved the very contrary. In the treatment of this deformity, he reproduces the accepted opinions and