a cavity into which the finger and sound had entered, and that there was a calculus at the most dependent part of the dilated pelvis. From numerous examinations in the post mortem room, too, I find that it is extremely difficult at times to be absolutely certain that the pelvis has been opened by an incision. Supposing, however, that the pelvis was properly opened, a second cause of failure may be found in the possibility of the stone having passed into the upper part of the ureter. A third explanation may be found in the existence of that rare condition a double pelvis, of which some curious examples have been described. The patient being incapacitated from work and apparently suffering greatly, I am wishful to re-examine the same kidney, but he is an extremely nervous man, and naturally shrinks from this in view of my not being able to give him something like positive assurance of relief. Should he consent, I propose to incise not the renal substance but the pelvis where it becomes ureter. Through a small opening here a silver sound would be able to explore the ureter freely, and to pass with certainty into the pelvis. If a stone be found, it could be removed by cutting directly on to it, the original opening in the pelvis being sutured. Case II. Severe Compound Fracture of Leg. Failure of Union in Tibia. Two Osteoplastic Operations Resulting in Firm Union.-T., aged 32, a carter by occupation, was admitted to the General Hospital under my care November 30th, 1885, suffering from a severe compound comminuted fracture of the tibia and fibula, with much laceration of the skin and soft tissues. Almost, I may say, against my better judgment I determined to try and save the limb. Many completely detached pieces of tibia were removed, but a bridge of bone was left posteriorly, so that no complete gap existed between the two main pieces of the bone; numerous drains were inserted, and a carbolized gauze dressing was applied. There was some suppuration and a good deal of skin sloughing, but the patient bore his trouble well, although Mr. Morrison, the resident surgical officer, and myself had great difficulty in keeping the limb splinted, owing to the destruction of the soft parts-sometimes a posterior, sometimes an anterior splint, then a lateral one, the position being changed almost from day to day; but we had at last the satisfaction of seeing the limb cicatrize almost completely, and the patient went to the Convalescent Home. In September, 1886, he again came under my care with the soft tissues of the limb sound and the fibula strongly united, but with a considerable gap between the pieces of the tibia. To remedy this I made an incision over the ununited fracture, removed the dense fibrous tissue from between the fragments, and scraped their ends. Finding then that they could not be approximated, I resected a piece about three-quarters of an inch long from the fibula, and then wired the ends of the tibia together. Although a good deal of disturbance of the soft parts was made, there was but little suppuration following, and scarcely any constitutional disturbance, and the patient was soon discharged from the Hospital with a fixed case on the limb. In January, 1887, the tibia being still ununited, I made a second attempt to secure union, thinking that failure may have been due to the sclerosed state of the tibial ends interfering with the production of sufficient reparative material. The ends of the tibia were therefore exposed and about a-quarter of an inch of very dense bone removed from each extremity, the wire of the previous operation being also removed. The fibula was then fractured, and to approximate the ends of the tibia—a very difficult matter-I introduced two steel knitting needles obliquely into each fragment and looped round them a stout silver wire, which succeeded for the time being, although there was a great strain upon it. By the third week all the needles had become loosened and were removed. There was again moderate suppuration, but the patient bore it well and eventually the wound healed. After many weeks of doubt it was evident that union was taking place, so the patient was allowed to put some slight weight on the limb which at length became quite firm, and in October, 1887, he was able to resume work with a strong limb nearly two and a half inches shorter than the other. REVIEW. 173 THE THEORY AND PRACTICE OF MEDICINE.* An The fact that this handbook has now reached its seventh edition is sufficient evidence of its popularity and success. The difficulty of compressing within a space of about 1,000 pages all the leading facts in medical pathology and treatment, and of allocating adequate space and emphasis to the more important details is one not lightly to be estimated. It is the experienced clinical teacher alone who can undertake such a task. accurate and extensive knowledge of disease must be combined with an intelligent appreciation of the requirements and difficulties of students, and there is further required a capacity for expressing, in the clearest manner, the essentials in the description of disease and its treatment. The admirable manner in which these conditions are fulfilled in Dr. Roberts' book is, without doubt, the secret of its success. Indeed, the very completeness of the work is surprising when we find faithful pictures of such affections as peripheral neuritis, Raynaud's disease, beriberi, and actinomycosis. These maladies have been brought into prominence by the discussions of recent years, and the brief and accurate descriptions in this edition will do much to familiarise students and practitioners with their phenomena. The earlier sections on general pathology have to some extent been re-written. We notice that special prominence has been given to the views of Macalister on fever as enunciated in his Gulstonian lectures, 1887. The advisability of admitting debatable hypothesis of this sort into a student's manual may well be called in question. By the bye, surely Febris sine febro is a printer's error. The theory of Beale that the bioplasm of *The Theory and Practice of Medicine. By Frederick T. Roberts M.D., B.Sc., F.R.C.P.; Professor of Materia Medica and Therapeutics, and of Clinical Medicine, University College; Physician to University College Hospital; &c., &c. 7th Edn. H. K. Lewis, London. 1888. the blood and tissues is increased in pyrexia is another of those hypotheses which never at any time had many adherents. It is more than once unnecessarily alluded to in this work. The old-fashioned English teaching as to the distinction between. croupous and diphtheritic inflammations of mucous membranes is still followed, while no allusion is made to the important pathological processes involved under the term necrosis. In discussing the treatment of diphtheria hardly sufficient reference is made to recent methods. The same may be said of the sections on the treatment of acute rheumatism, in which the value of salicylic acid and the salicylates is, in our opinion, not sufficiently insisted upon. Pasteur's inoculation treatment of rabies receives the author's support. The portion of the work devoted to nervous diseases has been edited by Dr. Beevor and bears evidence of a careful study of the best and most recent English authorities. Many omissions and errors which we noticed in former editions have been corrected. The author is to be congratulated on the position his work has won and maintained as a thoroughly reliable manual of reference and text book. RETROSPECT. NERVOUS DISEASES. BY C. W. SUCKLING, M.D., LOND., M.R.C.P., General Paralysis in Females-According to Dr. Siemnerling, Berlin (Le Progrès Médical, July 1888), the proportion of women to men suffering from general paralysis admitted into La Charité from 1880 to 1886 was one to three: The age in women most liable to the malady is between 36 and 40 years. The greatest proportion of the women were married. Amongst the unmarried, prostitutes numbered about six per cent. The causes observed by Dr. Siemnerling to be most conducive to the disorder appear, in this last class, to be their unfavourable social conditions, after which were syphilis and hereditary tendency. In a clinical point of view the author had directed special attention to the fixity of the pupil and the state of knee reflex. The first was present in sixty-four per cent. of the cases ; knee reflex was augmented in thirty-four per cent. The course of the disease is observed to be, generally, calmer than in men.— (The Provincial Médical Journal.) Amblyopia from Symmetrical Lesions.-Profound amblyopia without ocular lesions and with voluminous hæmatomata, comprising the whole of the occipital lobes, has been observed by M. Audry, and related in the Lyon Medical, No. 33. The patient was a man of 45 years, whose illness began three months before August, 1886, with headache, at first intermittent and then continuous. One month before admission walking became difficult and titubation well marked. Considerable loss of sight occurred about the same time, also noises in the ears with obstinate constipation and vomiting. The movements of eyes and lids were normal, and the pupils equal. He could not read; diplopia was not present. There was weakness of the upper limbs; knee jerks were absent; there was much swaying in attempts at walking, and a tendency to fall backwards. The pulse was fifty-six and regular; no albuminuria; no glycosuria. Later on the pupils did not react to light, and were constantly dilated. At the necropsy many clots and much fluid blood existed in the hæmatomata over both occipital regions, and the effusion was situated between the dura mater and the arachnoid. -(Lancet, September, 1888.) Visual Cortical Centres. La France Médicale, No. 93, records a fresh series of experiments by M. Vitzon on the situation and extent of the cortical visual centres. Munk considers the occipital lobe to be the only cerebral cortical region concerned in visual perception, whilst Ferrier, Yeo, Luciani and others include the angular gyrus. Vitzon has experimented on dogs of moderate size and, using Pacquelin's knife, has removed |