degree, and to which the freer mobility of the lumbar segment of the vertebral column at this point is owing, permit the lumbar vertebra, if its ligaments do not hinder, to slip out of its position under the weight of the body. This always happens in a forward direction, because the body of the vertebra is deeper in front than behind, because the normal bow of the column has the same direction, and lastly, because the lumbar surfaces of the sacral bone shelve forwards and downwards, favouring this forward gliding of the body of the superincumbent vertebra. In consequence of this dislocation, which may be complete, of the lumbar vertebra on the slanting upper surface of the first sacral vertebra, the intervertebral body is so compressed, that in the end its structure may degenerate and soon disappear. The consequent apposition of the bared articular surfaces entails other modifications. Ankylosis follows, distortion of the upper vertebral column, pelvic deformity, the most remarkable features of which are, defective space at the brim, projection of the symphysis, curvature of the sacrum, and elongation of the pelvis in its oblique diameter.

This summary is enough to show the leading features of this species of deformity, and to indicate its distinctness from the ordinary forms of rachitic distortion. The work itself is one exhibiting great minuteness of research, and will no doubt long remain the standard authority upon this rare but interesting form of pelvic contraction. The anatomical descriptions are illustrated by nine carefully-executed plates taken from the preparations.

ART. IX.-A Concise History of the Entire Abolition of Mechanical Restraint in the Treatment of the Insane, and of the Introduction, Success, and Final Triumph of the Non-Restraint System, together with a Reprint of a Lecture delivered on the Subject in the Year 1838, and Appendices containing an Account of the Controversies and Claims connected therewith. By ROBERT GARDINER HILL, F.S.A., M.R.C.S. Eng., late one of the visitors of the Lincolnshire County Lunatic Asylums, and formerly Resident Superintendent of the Lincoln Lunatic Asylum.-London, 1857. pp. 318.

THE non-restraint system of treatment of insanity is now very generally practised throughout England, and it forms the distinctive feature between the treatment in this country and that pursued in nearly every other part of the civilized world. The object of Mr. Hill's book is to place on record his claim to be the sole originator of the system. We are not disposed to depreciate Mr. Gardiner Hill's claims to be the sole originator of a great and good work. The following appears as impartial a statement of the case as we can gather of the claims and merits of Mr. Hill connected with the introduction of the treatment of insanity by non-restraint. Mr. Gardiner Hill was elected to the post of house-surgeon to the Lincoln Lunatic Asylum in 1836. Dr. Charlesworth was, and had been for some time, the visiting physician to the same institution. Dr. Charlesworth, following the example of Pinel, laboured assiduously to lessen the number and mitigate the severity of all mechanical restraints. Mr. Hill speaks of what had been achieved prior to his connexion with the asylum in the following terms: "the mildest period of restraint just prior to my connexion" with the Lincoln Asylum. Mr. Hill greatly assisted Dr. Charlesworth in his benevolent purpose, when, after reducing the number of applications of mechanical restraint to a very low ebb, it occurred to Mr. Gardiner Hill to abolish restraint altogether. Here precisely is the difficulty that has prevented Mr. Hill's claims from being rightly understood by some, and has afforded arguments to those who have opposed him. Restraint, Mr. Hill admits, had been reduced to the lowest point. But this reduction is not, as it may not appear to those not practically acquainted with all the details of the treatment of insanity, anything like the establishment of the principle of non-restraint-in fact, it is the very contrary. The merit consists not only in the origin of the idea, but in the elaboration of the system, founded upon the entirely novel principle of abandoning

brute force, and entirely ruling by moral influence. What, says Mr. Hill, is the substitute for coercion? The answer may be summed up in a few words-viz., "Classification and watchfulness; vigilant and unceasing attendance by day and night; kindness, occupation, and attention to health, cleanliness, and comfort; and the total absence of every description of other occupation of the attendants."

The controversy following the enunciation of the doctrine ran high at the time, and Mr. Hill found himself at last compelled to abandon his office. The system was taken in hand, however, by Dr. Conolly, and applied on the large scale at Hanwell Asylum in 1843, and since, under the fostering auspices of the Commissioners in Lunacy, it has spread to all the large asylums in England. The claims of Mr. Gardiner Hill were brought forward and acknowledged by Dr. Conolly, and also acquiesced in by Dr. Charlesworth, on the occasion of the presentation of a public testimonial to Dr. Conolly, and Mr. Hill was again involved in a controversy. The pleas of his opponents appear to have taken at different times every change, and resemble in this respect those of the defendant in the celebrated case put forward, when sued for damages for the broken looking-glass, which were, first, that the glass was broken when hired; second, it was whole when returned; and, third, it was never hired at all. Mr. Hill's opponents appear to have stated, first, that the non-restraint system possessed no merit; second, that the merit of it was due to others; third, that it was no new system at all.

This work may serve the purpose of the author in placing his claims on record, but we cannot say that it has any very great interest to the scientific reader.

ART. X.-Researches on Epilepsy: its Artificial Production in Animals, and its Etiology, Nature, and Treatment in Man. First Part of a New Series of Experimental and Clinical Researches applied to Physiology and Pathology. By E. BROWN-SEQUARD, M.D., Professor of Physiology at the Cooper Institute, N.Y., &c.-Boston, 1857. pp. 82.

In the general review of Dr. Brown-Séquard's researches which we gave a little more than two years ago,* we adverted to the interesting fact, that in animals in whom a complete or semi-transversal section of the lower spinal cord had been made, a convulsive affection supervened after the lapse of twelve or fourteen days, which closely resembled epilepsy. With the many other gentlemen who have had the advantage of attending the lectures of this distinguished physiologist, recently delivered in London, we have convinced ourselves of the epileptiform character of the convulsions thus produced. They occur spontaneously, but may be most readily produced by irritating a portion of the skin supplied by the second division of the fifth pair of nerves. In the book of which we have given the title above, Dr. Brown-Séquard presents to his readers a collection of the various papers which he has published on this branch of his inquiries into the functions of the nervous system since 1853. He investigates the history and pathology of epilepsy, with special reference to the results of his vivisections, and arrives at some conclusions which cannot fail to command the attention of the medical profession.

Our readers will find in the Physiological and Obstetric Reports of the present number, summaries of several of his recent papers, but we hope ere long to be able to offer to them an analysis of the labours of Dr. Brown-Séquard since the publication of our former review; we shall then especially examine his researches illustrative of epilepsy. We will now only express the hope that Dr. Brown-Séquard may see fit to publish in a collected, and, we would add, illustrated form, the entire course of lectures which he has recently delivered in London. The great interest which they have excited in the profession would be a guarantee to any publisher that he was consulting his own private advantage, quite as much as the advancement of

*Vol, xvii. p, 412. April, 1856.

science, by undertaking their speedy issue. In the mean time we would express our thanks to Dr. Brown-Séquard for again coming among us, and, with all the ardour and liberality of a genuine man of science, expounding to us the laws of nervous action which he has so laboriously, so patiently, and so successfully investigated.

ART. XI.-Observations on Venereal Diseases. By HAMILTON LABATT, A.B., F.C.D., Licentiate and Fellow of the Royal College of Surgeons, Ireland; Medical Officer of the South-Eastern Dispensary, Dublin; late in Medical Charge of the Second Battalion 60th Royal Rifles, &c.-Dublin. pp. 283.

M. LABATT's observations are founded chiefly upon his experience of the venereal diseases among soldiers. He informs us that 470 cases were admitted under his charge in the Dublin garrison during the late Russian war. In the 60th Royal Rifles 106 cases occurred, but no instance of secondary syphilis presented itself during eight months that he had charge of the depôt ! (p. 9.) With a view of pursuing the inquiry still further, M. Labatt obtained a return of the amount of secondary syphilis in the regimental and depôt battalion hospitals in Ireland during the months of December 1856, and June 1857.

"In the former month, 35 hospitals were opened, and the average amount of secondary syphilis in each hospital was 1gths-the whole garrison being 27.379. In the latter month -viz., June 1857, 81 hospitals were opened, and the average amount of secondary syphilis in each was 14. The command at this period numbered 19,019. These facts can only be appreciated by the military surgeon who is aware of the very great prevalence of syphilis in the army." (pp. 19, 20.)

The consideration of the causes of these favourable results forms the chief object of M. Labatt's work; and the solution M. Labatt thinks is to be found in those valuable restrictions which the characteristic discipline of the army enables the surgeon to carry out. Even for the simple primary ulcer, M. Labatt says that "perfect rest in the recumbent posture must be enjoined." (p. 59.) For the ulcer with elevated margin, smooth surface, and devoid of fungus, M. Labatt also recommends " perfect rest in the recumbent position." Now, if it were intended to imply that the favourable results obtained depend upon the peculiar mode of treatment, we may firmly say that the figures above given prove a great deal too much. In the first place we would question whether primary sores of the nature here described would, if left to themselves, produce, as a rule, any secondary symp toms; secondly, we have other statistics from the army in which it is not stated that any particular care was taken to keep the patient in a recumbent position, affording very favourable results. (See p. 31.) In the often-quoted cases treated by Mr. Rose, we have heard from authority which we cannot doubt, that while Mr. Rose believed he was treating his patients without mercury, they were in constant habit of going to unauthorized venders of medicine, who supplied them plentifully with that drug. They could not, therefore, have been kept at rest during their treatment, and yet the results published are sufficiently favourable. We must, then, seek some other explanation of the favourable results published than that of rest or other restrictions upon which our author lays so much stress. This problem at first sight appears by no means easy of solution, and we had thought of it for a considerable time before. In reading page 89, we came upon what appears to be the true explanation. M. Labatt there states that during the whole time he had charge of the military hospitals, but one example of the Hunterian chancre came under his observation. The remarkable coincidence of the rare occurrence of the Hunterian chancre and of secondary symptoms in M. Labatt's practice, confirms, as far as it goes, the non-infecting nature of the ordi

J

nary forms of sores which have come under his notice. And this we believe to be the true explanation of the comparatively few cases of secondary diseases which presented themselves under the treatment which he has advocated; nor do we believe that they would have been much more numerous under any other treatment. According to our view, the sores were in their nature non-infecting, and although a different plan of treatment might not have healed them so quickly, it would not have changed their nature so as to have converted them into infecting sores-by which we mean sores which have the property of infecting the patient's system. But still the question remains, why so small a number of infecting sores should present themselves in military practice? and this question is not very easily answered.

We believe that the secretion from a soft chancre will often give rise to another soft chancre, and that the discharge from a hard chancre will often produce a hard chancre. We also believe that after repeated exposure, the ulcerations almost always assume & soft character; they are communicated from, and give rise to, some form of suppurative inflammation. Now it is with persons who have been exposed to these frequent infections, and whose parts are very frequently affected by suppurative inflammation, that our common soldiers have to do, It would then appear, à priori, probable that often indulging in gregarious intercourse, they would, as a rule, be affected with soft or suppurating sores; and when we add to this the consideration of the early and frequent use of caustics in the army as tending to produce the same kind of inflammation, we have advanced some way in explaining the rare occurrence of secondary disease to which M. Labatt has so forcibly drawn our attention. We regard M. Labatt's work as a faithful record of what he has himself witnessed.

ART. XII-1. The Nature and Treatment of Cancer. Being the Address in Surgery read before the Twenty-fifth Meeting of the British Medical Association. By GEORGE SOUTHAM, F.R.C.S., Surgeon to the Manchester Royal Infirmary.-London, 1858. pp. 47.

2. On the Painless Extirpation of Cancerous Growths by Congelation and Caustic, including a Report of the recent use of Prolonged Congelation in the Cancer Wards of the Middlesex Hospital. By JAMES ARNOTT, M.D., late Superintendent of the Medical Establishment at St. Helena.-London, 1858.

pp. 28.

IN the able address delivered by Mr. Southam, before the meeting of the British Medical Association held in Nottingham, in 1857, we receive a lucid account and well digested critique of the prevailing doctrines regarding the nature and treatment of cancer. The author, while allowing the difficulties that surround the questions bearing on the origin and nature of the disease, maintains that no one pathological or clinical symptom is characteristic of malignant disease. He finds

"In the tendency of the growths to multiply themselves in the different textures of the body, to return after removal, and to present during some stage of the affection symptoms indicating constitutional vice, with its almost invariably fatal nature, the leading characteristics of cancer."

The author commences his remarks on the treatment of the disease, by expressing his belief that although a rare occurrence, it is occasionally cured. In proof, he quotes cases and statements of Sir Astley Cooper, Sir Benjamin Brodie, Mr. South, and M. Velpeau, and relates four cases of his own in which there were complete recoveries for nine, ten, nineteen, and twenty-two years respectively, or more properly speaking, in which after the lapse of these protracted intervals the disease had returned.

Mr. Southam is decidedly in favour of excision, as compared with caustic treatment, though he admits the occasional utility of the latter. The analysis of 150 cases examined by the author leads him to make the following statement

"Taking the average duration of life, from the first detection of the disease in those not operated upon, at four years, I think it may be inferred, that if the patient remain in perfect health and free from any return of the growth for three years after operation, it has added to the duration of life. Twenty-five cases exceeded this period, five of which lived for ten, twelve, twenty-seven, forty-five, and fourteen years respectively, after the removal of the tumour, the last mentioned being still alive. Symptoms indicative of the malignant cachexia do not appear to have been present in any of the twenty-five at the time of operation."

We cannot follow Mr. Southam further than to say, that he regards the application of ice and salt to produce local anesthesis as a valuable adjunct in the treatment by caustic. To the recommendation of this procedure, Dr. Arnott's pages are devoted. By the aid of frigorific mixtures graduated according to the depth to which he wishes to produce congelation, he destroys the sensibility of the parts, and is thus enabled to apply caustics without the production of the pain and its consequences, which result from the ordinary mode of application of these remedies. The subject is well deserving the attention of surgeons.

ART. XIII.-Summary of New Publications.

THE first work that we have to mention in this quarter's Summary of New Publications, and to which we hope in our next issue to draw the attention of our readers more especially, is the second edition of Dr. Bennett's Clinical Lectures on the Principles and Practice of Medicines.' 'An Essay on Physiological Physiology,' by Mr. Dunn; A Manual of Psychological Medicine,' by Drs. Bucknill and Tuke; a work by Dr. Noble, entitled, "The Human Mind in its relations with the Brain and Nervous System; and Dr. Roberts' Essay on Wasting Palsy,' or progressive muscular atrophy, mark the results obtained by various labourers in the field of neuropathology. This branch of science has received a fresh impulse from the brilliant experimental researches of Dr. Brown-Séquard, whose lectures have recently created such unprecedented interest in the metropolis, and the first number of whose 'Journal de Physiologie' will, with the second number, receive special notice in our Half-yearly Report on Physiology.

"The Institutes of Medicine,' by Dr. Martyn Paine, of New York, will command a very different class of admirers from that led by Dr. Bennett; we hope again to advert to it, as to the Essay on the Pathology of the Blood and its Containing Vessels,' by Dr. Wise. Mr. Lister, in an interesting paper On the Causes of the Coagulation of the Blood in Diseases of the Bloodvessels,' àpropos of a case of spontaneous gangrene from arteritis, follows up his former researches into the nature of inflammations, and arrives at the conclusion, that in the early stages of arteritis and phlebitis, the impaired vital energy of the vascular coats gives rise to an evolution of ammonia and consequent coagulation, with its sequelæ. The Proceedings of the Royal Society for 1857 contain the abstract of a paper, by Mr. Lister, On the Early Stages of Inflammation,' in which he reconciles solidism and humoralism, by showing how, in the production of inflammation, the withdrawal of the influence of a healthy part in the vicinity of the blood vessel operates in inducing the changes seen within the vessels. From France we have received a work, by Dr. Willemin, On the Waters of Vichy,' in which the author discusses their value in the treatment of chronic affections of the uterus, which his cases would argue as being very considerable.

6

Under the head of History of Medicine, we introduce to our readers the first volume of a work by Dr. Simon, of Hamburgh, entitled 'Kritische Geschichte des Ursprungs der Pathologie und Behandlung der Syphilis.'