conditions and degrees. A little practical work soon makes the subject quite simple to the operating surgeon, and there can be but little doubt that the pure flap-splitting operation (without special rectal and vaginal sutures) is better than the somewhat hybrid method described by our author.

ON CANCER OF THE UTERUS.*

THIS book is a reprint of the Harveian Lectures for 1886, together with the illustrations which were shown at the lectures but have not hitherto been published.

Dr. Williams divides his subject into three parts-1, Cancer of the Portio Vaginalis; 2, Cancer of the Cervix; 3, Cancer of the Body of the Uterus.

Under the first head, eight cases are narrated; under the second, nineteen cases; and under the third, seven cases. These are copiously illustrated by plates, the drawing of which leaves nothing to be desired. The interest of these lies mainly—and necessarily in the minute pathology of the disease, and can only be satisfactorily criticised by those who have devoted special attention to this branch of the subject.

Under the head of treatment the author advises simple amputation for cancer of the vaginal portion, and the supra-vaginal amputation for cancer of the cervix. He would restrict extirpation of the uterus to cancer of the body of the uterus.

On some points respecting which there is great diversity of opinion, it may be well to reproduce the author's own words.

"The starting point of cancer of the cervix is, in so far as I have seen, the cervical glands. I have seen no clear instance in which the disease originated in the epithelium of the surface." (p. 73.)

"It appears to me that the facts at present known, tend to show that lacerations play no part in the causation of cancer of the uterus." (p. 81.)

*On Cancer of the Uterus. By John Williams, M.D., F.R.C.P. London: H. K. Lewis, 136, Gower Street, W. C. 1888.

A PRACTICAL TEXT-BOOK OF THE DISEASES OF

WOMEN.*

EVERY stranger who has visited Paris will probably have vivid and, for the most part, grateful recollections of an illustrated map called the "Nouveau Paris Monumental." What this map does for the stranger in Paris the hand-book of Dr. Lewers may be said to do for the student in gynecology; for it is a striking and not unsuccessful attempt to combine the conciseness of a chart with occasional luxuriant descriptions of cases, or of special points in operative, clinical, or pathological teaching which are evidently favourite topics with the writer. The limitation which this method and the size of the book necessarily involve are at once the source of its strength and weakness. Its strength, because much of it is the outcome of earnest belief and practice; its weakness, because many diseases and methods of treatment are practically unnoticed or very inadequately described.

The advocacy of Hegar's dilators and the supra-vaginal amputation, the diagram illustrating the relative position of the ureters and cervix, the incorporation of some of the work of Matthews Duncan on parametritis and sterility, and of Dr. Williams on the uterine circulation, with the diagrams illustrating this on pp. 348 and 349, are all special and excellent features of the work. The chapter on flexions and versions opens well with the Schultze diagram of the normal position. It is a pity that Schultze's teaching with regard to the action of pessaries is not followed as closely. To write of a "fulcrum" in describing the action of a Hodge is inaccurate, misleading, and out of date.

Perhaps the least satisfactory portions of the book are those which treat of abdominal surgery and the knowledge of disease derived from this work. No mention is made of tuberculosis of the tubes, and the author hardly seems to be acquainted with

*A Practical Text-Book on the Diseases of Women. By Arthur H. N. Lewers, M.D., Lond. London H. K. Lewis, 136, Gower Street, W.C. 1888.

acute pyosalpinx-a very different disease to the chronic affections of the tubes, which are treated of in chap. xiii. Under the head of hæmatocele, both varieties (intra and extra-peritoneal) are described alternately as regards morbid anatomy, symptoms, and diagnosis in a way that is not conducive to clear thought or distinct memory, and it would be a decided improvement to treat them separately. On p. 273 we read the following" When the blood is effused into the peritoneal cavity it gravitates into Douglas's pouch and coagulates; in twenty-four hours the coagulum has become enclosed by adhesive peritonitis." Anyone who has opened the abdomen for hæmorrhage will know how imperfect such a description is. It may be approximately correct for a limited hæmorrhage, but the acute affection is practically ignored.

No mention appears to be made of the most frequent cause of extra-peritoneal hæmatocele, which is menstrual congestion subsequent to operations involving the broad ligaments. This is important, and should be known by the medical practitioner of our times.

But in spite of these faults the book is a good one and will probably be appreciated by many. It is a small book, and this is a pleasing feature to the wistful gaze of the examinationdreading student. But will Dr. Lewers be able to keep it so?

SURGICAL APPLIED ANATOMY.*

TREVES' book is one of the best known of Cassell's manuals, and has run quickly into its third edition. No better proof could be supplied of the estimation in which the volume is held. In the present edition the work has been carefully revised throughout, many sections have been entirely re-written, and much new matter has been added. Every effort has been made to bring each chapter up to date.

* Surgical Applied Anatomy. By Frederick Treves, F.R.C. S., Surgeon to the Lecturer on Anatomy at the London Hospital. Illustrated; third edition. London: Cassell & Co. 1888.

THE PRINCIPLES OF CANCER AND TUMOUR

FORMATION.

THIS Volume is presented "as an introduction to a contemplated treatise on the Pathology and Treatment of Cancer and Tumour Formation," five other parts being promised to complete the work, so it will be realised that the author has undertaken an ambitious task and one which may well exceed the scientific and clinical attainments of any individual observer. The present volume is devoted to a study of tumour formation from the evolutionary stand point, the argument being divided into five chapters: on Growth, Reproduction, the Evolution of Vegetable Neoplasms, the Evolution of Animal Neoplasms, and Ætiology.

It is impossible in the limits of a brief review to discuss at length a book which it is obvious demands close criticism, as only an indication of some of the prominent features can be given here. In the first chapter, growth is considered as it is exhibited in crystals, in the vegetable, and in the animal cell, the opinion being expressed that "the tendency of modern science. is to break down the partition between the organic and the inorganic; and to shew that both are governed by the operation of forces, which are the same in kind, though differently compounded," but at the same time it is acknowledged that "when crystals are dissolved and re-crystallized the same forms are reproduced again and again, but the combinations which determine organic forms, repeat themselves hereditarily and at the same time they undergo change." "Heredity is the cause of the stability of organisms, and adaptation of their modification." At p. 19, occurs the following, "Blood and lymph vessels and nerves have not the slightest direct influence on the processes of growth. These are only of importance in so far as they regulate the supply of nutriment, etc. In plants, the early embryo and the lowest animals, all the phenomena of growth go on without them." In those organisms where a nervous system has not been traced, no doubt this is true, but it does not follow that it

*The Principles of Cancer and Tumour Formation. By W. Roger Williams, F.R.C.S. London: John Bate and Sons.

is equally true when there is a higher state of differentiation of tissues, and it seems to us contrary to a considerable amount of evidence as to the direct effect of nerves on the nutrition of the tissues of the higher animals, and on some of their glandular secretions.

In the chapter on reproduction we find "the study of reproduction and its laws is, therefore, an essential preliminary to the study of the etiology of cancerous tumour formations. It is the physiological prototype of these pathological processes." The methods and details of cell production are then described at some length, but we doubt if there is yet sufficient evidence to justify the statement that all animal and vegetable cells originate by karyokinesis. One of the most important ideas formulated is as follows, p. 44: "In the course of development from originally like units (blastomeres), as the process of division and differentiation proceeds, many cells acquire special functions, and much of the original protoplasm is used up and converted into special tissues. In proportion as the cells are thus specialized, we may infer they lose their primitive general functions. Thus their power of reproducing the whole organism may be greatly reduced or altogether lost, owing to all or the greater part of the original protoplasms being specialized and used up. But in the higher organisms certain cells never attain a high degree of development; they remain in a lowly organised condition, and serve, according as they are more or less unspecialised, either as germs for reproducing the entire individual or for forming and maintaining the various tissues and organs. Such cells are found in all growing parts; they are the only real cancer and tumour germs, as I shall hereafter shew."

The chapter on the evolution of vegetable neoplasms is perhaps the most original of all, and embodies to a great extent the material brought by Mr. Williams before the Pathological Society some two years ago.

In chapter iv. neoplasms are classified according to the division of the germinal layers suggested by His into archiblastic and parablastic, not on the ground of the correctness of His's subdivision, but because "it is perfectly natural and convenient."