The last sentence is as follows: "The prudence and skill of the physician, the care and good sense of the nurse, and the proper selection of the fit remedy, decide the patient's fate: Venesection and alcohol, tart. antimon. and quinia, opium, ipecac, calomel, veratrum viride, iron and copper-each of them may do good service, or may inflict serious injury." It needs no professor to tell us that. C. E. B. SYNOPSIS OF THE COURSE OF LECTURES IN MATERIA The character and scope of this book are sufficiently well described in the following extract from its prefatory notice. "The motive which has influenced me in compiling the work from my manuscript notes, is the desire to give the pupils of the University a thorough knowledge of the important branch of medicine which it is my duty to teach. To the character of an independent treatise the work presents no claim; in fact, a large proportion of it requires the explanations given in the lecture C. E. B. room." OBSERVATIONS ON THE NATURE AND TREATMENT This monograph, as is stated in the preface, "is not put forth as a complete account of polypus of the ear, but simply as a contribution to the study of it." Coming as it does from one of our most eminent physicians, and from one who has enjoyed in addition the advantage of an exceptionally large practice in aural surgery, we naturally expect and we find facts carefully observed, thoroughly studied, and clearly reported. These facts, moreover, are sufficiently numerous to admit of some general deductions of great practical utility. They show also that polypus of the ear is a comparatively rare disease, a fact which goes far to explain both the meagreness of statement and the marked discrepancies upon this subject which characterize the works of nearly all the sys ཨ་ཎྚ། I 3 tematic writers on the diseases of the ear;-the same fact explains and must also excuse similar deficiencies in the present monograph. While therefore we had formed expectations of the book which are not wholly realized in reading it, we have nevertheless every reason to feel grateful for the work that has been done, and especially that it has been done so well. The first part of the book, comprising about two-thirds of the whole, is devoted to the record and analysis of cases, thirteen in number, of which the dates are not given, but which, as we learn from the preface, were observed and recorded several years ago. The remaining pages are of recent composition, and contain a digest of the conclusions drawn in the first part supplemented by the author's later but unrecorded experience. The principal conclusions drawn by Prof. CLARKE from the cases which he has reported may be thus briefly summed up. Ist. That neither the sex, age, nor general health of the patients had much to do with the polypi in their ears, but rather that the growths sprung up in consequence of local causes, and grew because they found an appropriate soil. 2d. That a discharge from the ear was always one of the first symptoms, and sometimes the first and only warning of impending or existing evil. The inference drawn from this observation is that polypus is rather the result than the cause of the otorrhea; hence the conclusion that every case of discharge from the ear should be examined and treated as soon as it appears, not left to itself in the hope that it may get well spontaneously. 3d. That polypi of the ear are of all possible shapes and sizes; some are pedunculated, and others attached by a broad surface; that they may grow from various parts of the external meatus, but more from the middle than from the inner or outer third of its length, seldom from the membrana tympani or from the cavity of the tympanum; that in structure they may be arranged in two groups or classes, according as they present a fibrous or a cellular character when examined by the microscope. These two varieties Prof. CLARKE designates by the names "fibrous" and "epithelial," and under one or the other of these heads he classes all the non-malignant growths of the meatus. 4th. That polypus of the ear is almost always preceded or accompanied by other serious disease of the meatus, and in more than half the cases by perforation of the membrana tympani ; therefore, 5th. That although the effect of treatment is always in the end satisfactory as far as the effectual removal of the polypus is concerned, yet 6th. The result of treatment on the hearing depends more upon the integrity of the membrana tympani and of the deeper parts of the ear than upon the successful removal of the polypus. 7th. That the treatment is by extraction and cauterization, the time required for a cure varying in the cases reported from a single day to four years, or an average of nearly six months. The classification of polypi proposed by Prof. CLARKE has the merit of great simplicity, but practically, it appears to us that it does not materially differ from the well known arrangement proposed by Mr. TOYNBEE, and now very generally adopted by aural surgeons. Prof. CLARKE's "epithelial" and "fibrous" polypi seem to us to correspond in fact to the "raspberry cellular" and "fibro-gelatinous" growths of Mr. TOYNBEE, with only this difference, that while Mr. TOYNBEE'S description is, like the former, founded chiefly upon considerations of minute structure, it takes cognizance also of other distinctions drawn from the study of external appearances and of concomitant symptoms. form, however, which Mr. ToYNBEE has most carefully described, and which, he says, "differs essentially from those belonging to the preceding classes," viz., the "globular cellular" polypus, is not noticed in Prof. CLARKE'S system. This seems to us an important omission, inasmuch as this form of polypus, as described by Mr. TOYNBEE, is peculiar from the fact that it does not require to be removed by operation or by caustics, but can be successfully treated by astringent solutions of moderate strength dropped into the ear. A truly scientific classification of aural polypi, as it appears to us, remains still to be achieved; by this we mean a classification based upon their homologies with growths from other portions of the cutaneous surface of the body, and it is from investigations conducted in this broader way, rather than from the exclusive study of the disease of any single region, that we look for the coming light. The book is admirably printed on tinted paper in the best manner of the Cambridge press, and is illustrated by two exceedingly well executed plates representing the minute structure of the growths described in the text: for the microscopical examinations and drawings, credit is given to the author's friends, Profs. JOHN BACON and CALVIN ELLIS of Boston, and JOHN C. DALTON of New York. In conclusion we would say that the book fulfills the promise of the preface, and is a valuable contribution to the study of polypus of the ear. J. G. TREATISE ON THE Diseases oF THE EYE, including the This standard work, having attained its third German edition, now appears for the first time in an English version. It was sent unfortunately too late to admit of its receiving an adequate review in the present number of the Journal, and we are unwilling to do injustice either to the author or to the faithful translators and editors by anything less than a careful perusal of the whole work. We must therefore reluctantly content ourselves with a simple endorsement of the book as the most complete and trustworthy compendium of ophthalmology that has been offered to American physicians since the appearance, many years ago, of the great, but now in many respects obsolete works of MACKENZIE and LAWRENCE. We hope to be able in our next number to give an extended analysis of its contents. J. G. LECTURES ON THE DISEASES OF WOMEN. BY CHARLES WEST, M.D, F.R.C.P.; Examiner in Midwifery at the University of London; etc., etc. Third American, from the third and revised English edition. Philad. Henry C. Lea. 1867. 8vo., pp. 543. Price, $3 75. The popularity of WEST's work on diseases of women relieves us from the necessity of recommending it at length, and will secure this new edition a warm reception. We believe this is the most popular of all the works upon the same branch, and, though the contestants for professional favor are numerous in this field, the one that, in the judgment of the majority, fills the highest place. Not alone is the instruction imparted in this volume reliable in a high degree, for his writings attest the conscientious observation and truthful relation of the author, but all subjects are presented in language most agreeable to the reader: an easy, charming, perspicuous style, that makes it a pleasure to read, is one of those characteristics of the work which secure its elevated position among its rivals. The only recent work that bids fair to compete successfully for equal favor is that of GRAILY HEwitt. Yet there is an intrinsic difference in the two works which will allow them to stand peacefully side by side, partly from a wholly different method of treating their subjects, and partly from the standpoints of the authors being different. Dr. WEST may be called, at this day, an eminently conservative gynæcologist-that title even is hardly appropriate, for "gynæcology" is the word almost monopolized by the radicals,-whereas Dr. HEWITT may be said to strike the average and be extreme on neither side, yet inclining decidedly more to the younger school than Dr. WEST. One essential change of this edition we must not permit to pass unnoticed it is the change of opinion in regard to ovariotomy. In the first edition of his lectures, the author expressed the most unfavorable opinion on this operation and showed himself a strenuous opponent. The additional developments and experiences of the seven years which have passed over that edition have induced the author to alter his opinion, and we take the liberty to illustrate this change by quotation from the pages of the work. After repeating all his former reasons against the operation, Dr. WEST goes on: "It is between six and seven years ago since I expressed these opinions. I have thought it right to reproduce them now, word for word, and to repeat the grounds on which they rested. I have done so because these opinions are still in the main those of the highest authorities in France and Germany, and it is only in this country and in America, that any important additional experience has been attained concerning the operation and its results. "Even in England, most of the former opponents of ovariotomy retain the unfavorable opinion which they had already expressed, but I am not aware that anything whatever has been done, or even attempted by them to devise other and less hazardous proceedings for the cure of ovarian disease, or even for retarding its progress; and iodine injections, which seemed to promise so much, have been allowed to fall into disuse, almost without an attempt to ascertain their real value. Ovarian disease, then, remains, as far as curative measures are concerned, just where it was seven years ago; a deeper conviction of the utter fruitlessness alike of interna! |