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abscess. He had seen a case of recto-vesical fistula, like thatrelated by Mr. Hawkins, in which there were no premonitorysymptoms.

Dr. DRYSDALE related a case of obstinate diarrhoea, in whichhe considered there was some organic mischief likely to requirean operation.

Dr. SYMES THOMPSON mentioned a case of diarrhoea inwhich the evacuations were mixed with a large quantity ofwatery fluid. In this case there was a communication betweenthe ovary and the rectum.

Dr. ROBERT LEE referred to a case of cancer of the uterus,which spread to the rectum, and from which the patient dieda miserable death. He inquired of Mr. Curling whether hehad performed an operation in such a case.Mr. CURLING replied that in the case in which he had ope-

rated great relief was afforded, though, of course, no perma-nent benefit followed. He had not since seen a case in whichhe had advised the operation; but he believed there were ex-ceptional cases in which an operation might be performed withthe result of affording some relief to suffering.

Dr. ROBERT LEE had seen 400 cases of cancer of the uterus,and had come to the conclusion that no method of treatmentwould stop the progress of the disease. He had once tried toremove the cancerous mass by ligature, but without any bene-fit ; and in one or two cases in which a similar proceeding hadbeen resorted to, haemorrhage to nearly a fatal extent ensued.All kinds of escharotics had signally failed of success ; and insome instances had only aggravated the symptoms, and acce-lerated the fatal result. Yet in these cases a cure had actuallybeen promised ! You might relieve symptoms in cases of cancerof the uterus; but it was useless or worse to attempt its ex-tirpation.

Reviews and Notices of Books.A PracticaL Treatise on the Physical Exploration of the Chest,

and the Diagnosis of Diseases affecting the RespiratoryOrgans. By AUSTIN FLINT, M.D., Professor of the Prin-ciples and Practice of Medicine in the Bellevue HospitalMedical College, and in the Long Island College Hospital.Second Edition, revised. Philadelphia : Henry C. Lea.1866.

AFTER an introduction, in which he gives a short sketch ofthe anatomy and physiology of the respiratory organs, anddescribes the topographical divisions of the chest, Dr. Flintdivides his work into two parts. Part I. is prefaced with anintroduction containing some thoughtful and most judiciousremarks on the value of physical signs, and on the best methodof cultivating a knowledge of them; and then the variousmethods of physical exploration, and the phenomena elicitedby means of them in health and disease, are considered in

turn. To each mode of examination is appended a shorthistorical account; and, while assistance is rendered to the

reader throughout by means of tabular views, at the end ofthe part there i3 a carefully compiled table, which exhibits ata glance the various morbid physical conditions, their physicalsigns, and the diseases in which they occur. In opposition to Skoda, Dr. Flint attaches great value to the

pitch of the percussion note ; and he also holds that an atten-tion to the pitch of the various morbid respiratory sounds isof the utmost value in diagnosis, enabling us, for example,at once to distinguish simple exaggerated respiration from thebroncho-vesicular respiration due to slight consolidation, andtubular breathing from true cavernous respiration. His systemof nomenclature and classification of the phenomena, of auscul-tation is simple, comprehensive, and laudably free from thattendency to over-refinement of distinction, and consequentmultiplication of terms, into which so many writers havefallen. It is greatly to be regretted that since the time ofLaennec scarcely any two writers have used the same termi-nology, or adopted the same classification, and that they havenearly all invented new terms, or altered the original significa-tion of the old ones, so that now every auscultator has a

system of his own, intelligible only to himself and his pupils.Surely an endeavour should be made to attain some exactitudeand uniformity in this matter. Can no suitable system, havinga definite meaning attached to each term, be universallyadopted, so that the exact meaning and significance of anydescription given of morbid respiratory sounds may be at onceunderstood by all ? His remarks on the various phenomena ofvocal resonance, especially those incident to the whisperedvoice, are well deserving a careful perusal.In Part II. the physical signs presenting themselves in each

disease are very fully described, and the symptoms consideredin so far as they affect the diagnosis. The chapter on Phthisisis replete with interest; and his remarks on its diagnosis, es-pecially in the early stages, are remarkable for their acumen andgreat practical value. Chronic pleurisy, by which the authormeans chronic inflammatory effusion, is a disease to which hehas devoted considerable attention. He points out that it

rarely follows the acute form ; but that, in the majority ofcases, it is subacute from the first, and is often remarkablylatent. He justly observes that chronic pleurisy is commonlycharacterised by an amount of effusion which only occasion-ally occurs in the acute variety. He considers that empyema,though in some instances a result of acute or chronic pleuritis,is a " form of pleuritic inflammation differing from ordinarypleuritis, ab initio, in a tendency to the formation of pus."The author concludes with a chapter on the Diagnosis of Dis-

eases of the Larynx and Trachea, in which, while fully admit-ting the value of the laryngoscope, he refers the reader for in--formation respecting its employment to monographs treatingspecially of its application.

Dr. Flint’s style is clear and elegant, and the tone of fresh-ness and originality which pervades his whole work lends anadditional force to its thoroughly practical character, whichcannot fail to obtain for it a place as a standard work on dis-eases of the respiratory system.

ly7te Law relating to Public Health and Local Governnaent :-including the Law relating to the Renaoval of Nuisances in-jurious to Health, the Prevention of Diseases, and SewerAuthorities; with the Statzttes and Cases. By W. CUN-NiN&HAM GijEjr, Esq., Barrister-at-Law. Fourth Edition.Small 8vo; pp. 1000. London: Butterworths; and Knightand Co. 1866.

THIS work is devoted to the laws relating to the publichealth, the execution of which devolves upon the local au-thorities. To adopt the author’s words, " It contains thewhole law of I local self-government’ in relation to the con-servation of the public health, and to all those numerous mat-

ters upon which life, health, and property depend." Those

sanitary laws in which the local authorities (otherwise thanboards of guardians and overseers) acting in the matter ofnuisances injurious to health are not concerned-such as thelaws relating to vaccination, contagious diseases in militaryand naval stations, &c.-are but briefly touched upon. It

may be well to mention, however, that the Quarantine Actcomes within the scope of Mr. Glen’s work, and is includedamong the statutes in the appendix.The important additions made by the Legislature to our

Sanitary Laws in 1865 and 1866, particularly the SewageUtilisation Act of the former year and the Sanitary Act of thelatter, have made this edition of Mr. Glen’s work imperative.He adheres to the original arrangement of the work. First,he gives an elaborate treatise on the Law of Public Healthand the Local Government of Towns, in which the require-ments of the different Acts of Parliament are clearly explainedand elucidated by the numerous decisions which have beenpronounced in courts of law upon their construction. The

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second part contains the different Sanitary and Local Govern-ment Acts which are explained in the treatise.

In the first portion of the work the following subjects aretreated of in succession : (1) the formation of the districts ofthe local boards, the constitution of those boards, and theirelective and general powers ; (2) their powers as to sanitarymatters, and the local government of towns ; (3) the powersof local boards as to rating, raising money on mortgages of therates, purchase of lands, audit of accounts, contracts, arbitra-tion, legal proceedings, bye-laws, and other miscellaneous sub-jects ; (4) the removal of nuisances injurious to health; (5)sewage utilisation and the constitution of sewer authoritiesunder the Acts of 1865 and 1866; and (6) the law relative tothe prevention of epidemic, endemic, and contagious diseases.To all who have an active concern in the laws relating to

the Public Health and Local Government Mr. Glen’s work will

prove invaluable.

New InventionsIN AID OF THE

PRACTICE OF MEDICINE AND SURGERY.

ARTIFICIAL ARMS AND LEGS.

WE have had some artificial limbs submitted to us for

our inspection, made by Mr. J. Gillingham, of High-street,Chard, Somerset. The novelty of these instruments consistsin the extreme lightness of the material employed, as alsoin the manner of adjustment. We have notes of a casefrom which we make the following abstract. A gamekeeperin the service of Lord Bridport, whilst firing a salute on theoccasion of the marriage of the Prince of Wales, was ramminghome a charge of powder, when it exploded and forced theramrod through the humerus, causing so much mischief thatit was necessary to remove the arm at the shoulder-joint,which operation was performed by Mr. Spicer, of Chard. Thecase was explained in London to several surgical instrument-makers, but they said that they could not adapt an instrumentto be of any practical use, but could make one which wouldrestore the natural appearance of the limb. By Fig. 1 it will

Ibe seen that there is no bearing to be had from any stump; ,,

FIG. 1. FIG. 2. ’

therefore the bearings had to be made from the sound side, asis well shown in Fig. 2. The instrument is adjusted by meansof a kind of corset, which has a prolongation over the soundshoulder, as well as under the axilla. Such has been the suc-cess of the apparatus, that the man can now raise as much asa hundredweight, can wheel 4 barrow, carry water, and rest a

gun whilst shooting. The latter movement is accomplishedby means of a chain and hook at the elbow-joint, which byadjustment can be made to raise the forearm to any angle.We have also seen a leg made on the same principle. Theseinstruments can be manufactured at a very cheap rate, and thematerial of which they are made enables the maker to fit a

patient with more than usual accuracy. Cheapness is a greatrecommendation, as it will place a most useful artificial limbwithin the reach of those who, under other circumstances,would have to put up with an unsightly stump, or an equallyugly wooden leg.

WHITE TROOPS OR INDIAN TROOPS FORHONG-KONG.

To the Editor of THE LANCET.

SIR,-In your last issue you state that " everybody is agreedas to the wisdom of replacing white troops in Hong-Kong byAsiatic troops," and naturally ask, " Why is it not done?" I think you will find that the Horse Guards and War Officeauthorities have pursued their usual "penny wise and poundfoolish" policy in withdrawing the Indian troops from China ;for as long as the garrison consists of unmixed troops, theirpay is "imperial, with colonial allowance," instead of, as

formerly, "Indian pay and allowances." This is economyfrom an official point of view. Is it not also the intention ofGovernment to adopt the same measure with regard to theStraits, and for a similar reason? Surely, enough has beensaid and written to prove, that if European soldiery must bekept at Hong-Kong, more salubrious sites than those of theMurray and Artillery Barracks and General Hospital shouldbe chosen, and suitable buildings erected for their respectivepurposes. And the same improvements are quite as urgentlycalled for in the wretched huts in which the native troops (inmy time) were quartered. The present sites, especially thoseof the Artillery Barracks and General Hospital, are, in a com-mercial point of view, most valuable ; in a sanitary point ofview, as bad as possible. Ever since the possession of thatdistant island, we have witnessed how deadly its sicklyseasons have proved to our troops, and how utterly unfittedfor further service a protracted residence there renders thosewho do not succumb to its baneful influence. Of late yearsthe statistics of the 59th, 1st, and 20th Regiments, will con-vince anyone of these painful facts. It is not too much to

expect that, if we must maintain a European force in China,not only should they receive good pay, good quarters, suitableclothing, and the best of rations procurable, but be supportedby the cheering knowledge that this terrible exile is only toendure two, or, at the very most, three years. It is no morestrange than true, that in our most unhealthy possessions areto be found, not only the very worst barracks, but otherneglected hygienic conditions upon which the health andefficiency of our army mainly depends. It has been clearlydemonstrated that bricks and mortar, food and raiment, arefar cheaper materials than flesh and blood; whether our mili-tary and financial authorities are prepared to admit the axiomor not. To condemn the unfortunate soldier’s wife and familyto such a climate as that of Hong-Kong, and, I think I maywith-truth and prudence add, India, is something worse thancruelty; but what provision to make for these too oftenneglected and destitute creatures, I must leave to a paternalGovernment to devise. I must add, from what I have seenof married life, in the ranks, in both India and Chma.. tha.t Iam one of those who would be glad to see it prohibited entirely.Since the recently acquired territory of Kowloon, on the oppo-site side of Hong-Kong Bay, has proved so unhealthy, I wouldsimply suggest the choice of ground on the south-western partof the island, which, I believe, is now admitted to be thehealthiest part, and is being eagerly bought up by thewealthier merchants and others for villa sites.

I am, Sir, your obedient servant,Jan. 10th, 1867. VOYAGEUER.

IT was reported to the meeting of Governors of theSir Patrick Dun’s Hospital, Dublin, on the 8th inst., that 180cases of Asiatic cholera had been admitted into the hospitalsince the beginning of the epidemic (August 2nd)-viz., dis-charged cured, 95 ; died, 85