on many of its meadows." Surely this is a mouth-watering picture of a spring abode, at least to us dwellers in Birmingham with the canvass of its climate so crowded with constant changes, and these, alas! so Plutonic that we cannot but be reminded of the various realms in Dante's Inferno, and moodily groan out with Milton's Satan, "And in the lowest deep, a lower deep still threatening to devour me opens wide."

Half-way Resting-places.-But Wiesen is by no means the only place of refuge; the triple village of Tarasp, Schuls, and Vulpera, especially this last hamlet, is a most agreeable change from St. Moritz or Davos. It is situated in the Engadine, some dozen miles below Süs, at an altitude of 4,300 feet, and is unusually well protected from winds of all kinds. Thusis, at the foot of the Via Mala and at an altitude of 2,448, is a good resting place; but it is too low for a prolonged stay and is more fitted for a half-way house, either going to or coming from the mountains, than as a mere change of abode.

Promontogno, 2,687 feet, in the middle of the splendid Val Bregaglia, and half way between the Maloja and Chiavenna, has a good hotel fitted to receive patients, and is able, like Thusis, to act as a half-way house, or to receive fugitives from the snow melting in the Upper Engadine-this is only one and a half hours, eleven miles journey, from the Maloja. Just below it the road passes through a most picturesque gateway cut in the rock, which forms the upper limit of the chestnut, a fruit which forms the staple commodity of the pretty hamlet of Castasegna.

Seewis is delightfully perched above the valley of the Praettigan, about seven miles from Landquaart, at an altitude of 3,000 feet t; it has two good hotels, and forms an excellent half-way house and good spring resort.

Davos and the Engadine compared.—As to the rival virtues of these various spots they may be stated in a nutshell. The Maloja has the most sunshine and perhaps the longest winter; but it has these drawbacks: most wind, especially the föhn which rushes up the rocky rampart separating the Val Bregaglia from the

Engadine just over the ridge of which rampart stands the Maloja Kursaal-too great nearness to the Lake of Sils with its cold damp mists.

St. Moritz has nearly as much sunshine as the Maloja, but this leaves it twenty to forty minutes earlier in the day: about 3.0 instead of 3.30; this is a by no means despicable difference, as it curtails the walk after luncheon. But it is much better protected from the wind and is well above any evil influence from the St. Moritzer See.

Davos Dörfli (5,160 ft.) resembles St. Moritz in its sunshine. and in the amount of wind, but its accommodation is far less luxurious, a perhaps not unmixed evil, as the evening entertainments at Platz and St. Moritz very likely do as much harm as good.

Platz (5,115 ft.) has an hour's less sunshine than the Maloja, but is protected from the wind best of all, and being 950 ft. lower than St. Moritz is less stimulating and trying to the circulation. Socially, too, it easily bears off the palm: some three hundred English reside in the hotels every winter, besides others living in lodgings and private villas. It no doubt will always prove the most generally suitable to the average invalid.

Finally my advice would be, if you are strong enough, have sufficient backbone, go to the Engadine and by preference St. Moritz if it grow too monotonous drive over some fine day in January to Platz and spend a month in Davos: then drive down with the first approach of snowmelting to Wiesen and stay there till June when the Engadine again becomes delightful.

And thus with the same or similar variations remain up in these elevated regions for at least one year after all signs and symptoms of your disorder have vanished and return to them again on the first appearance of any fresh outburst.

With reference to phthisis I would say: many cases no doubt get well at home, even amongst the poor: I remember patients at Brompton who had paid that hospital their first visit twenty and more years previously. But in these Alpine villages the majority seem to improve if they do not get well; and a far larger actual arrest takes place than in our own moist and lowlying climate.

REVIEWS.

33

THE DISEASES OF THE BREAST.*

MR. BRYANT's treatise is the most recent of the well-known clinical manuals for ractitioners and students of medicine, published by Messrs. Cassell, and as might have been anticipated, from the author's ability and experience in his subject, it is one of the best volumes of the series. The object he has kept in view in writing the work has been to place before the student and practitioner a clinical exposition of the abnormalities and diseases of the breast, more particularly with reference to their diagnosis and treatment. With this view the descriptions of pathological conditions are not placed in the foremost position, they are referred to only to elucidate clinical phases, and to show how the signs and symptoms of local disease are to be explained by progressive pathological processes. The book is illustrated with nineteen engravings and thirty-one chromo-lithographs, the latter being both artistic and useful.

The chapter on abnormal conditions of the breast and nipples is most interesting, and particularly that part which treats of supernumerary glands. We should like to have seen more prominence given to the therapeutic agent, pressure, in the treatment of breast inflammations.

We are glad to see special chapters devoted to "Scrofulous swelling of the Breast," and to "Syphilitic Mastitis," because, although not common conditions in our experience, they undoubtedly occur from time to time, and are seldom recognised for the reason that they have no place in the mental catalogue of the majority of practitioners.

* The Diseases of the Breast. By Thomas Bryant, F.R.C. S., M.Ch. Senior Surgeon to and Lecturer on Surgery at Guy's Hospital, &c. Illustrated. London: Cassell & Co. 1887.

C

The chapters on tumours naturally occupy the bulk of the volume, and the author accepts Dr. Creighton's views "that tumour disease of the breast is essentially a disorder of function." Tumours are dealt with rather from the standpoint of the clinical surgeon than of the pathologist, and in this we think is to be found the book's greatest merit. Special chapters are devoted to "adenomata and adenofibromata," "adenosarcomata,” “carcinomata,” and “cystic tumours," the remaining occasional growths-such as chondromata, angiomata, hydatids, etc.-being treated more generally.

A writer on such a well thrashed out subject as mammary growths cannot possibly thrill his readers by startling original truths. We are not surprised therefore to find little that is new under this head. We cordially agree with Mr. Bryant in his protest against the undue importance which is generally attached to the retracted nipple as a sign of malignancy, and of the dimpling of the skin as a feature of lipoma. His observations on that form of cystic degeneration which affects the breasts of women beyond forty years of age-often diagnosed as "cancer" -are especially deserving of attention.

The value of the book is immensely added to by special lectures on "How to Examine a Breast," "A Summary of the Diagnosis of Tumours of the Breast," "On the Presence of more than one Neoplasm in the same subject, and on the Shrinkage of Tumours," and "A Series of Cases Illustrating the Clinical Symptoms and Treatment of Carcinoma."

The author has given the profession the benefit of his long experience and unusual opportunities, and we venture to predict that practitioners will be grateful to him for it. As a book for students preparing for examinations only might fault be found with it.

THE LETTSOMIAN LECTURES.*

THREE lectures are herein contained, and their general excellence demonstrates the wisdom of the Medical Society of London in selecting this eminent provincial surgeon as their Lettsomian lecturer.

Lecture I. deals with urine fever and with the formation of stricture tissue. The first Mr. Harrison regards as due to the absorption, through a recently wounded urethral surface, of some alkaloid produced by the decomposition of urine pent up in relation with the solution of continuity. As a corollary to this he advocates complete drainage and antisepticism. The drainage advocated is by external urethrotomy even when there is no evidence that an injury has led to extravasation, and the same plan is recommended in the treatment of stricture not suitable for dilatation, sometimes in combination with an internal urethrotomy for the division of the cicatrix. Stress is laid upon the possibility of "sterilizing" the urine by administering quinine or boracic acid by the mouth, each of these being excreted by the kidneys, and thus rendering the urine less likely to decompose. Some original remarks are made on the importance of a perfect condition of the epithelium lining the urethra. In the light of the views here put forward, stricture is regarded not as a direct product of gonorrhoeal inflammation, but rather as a conservative change. Gonorrhoea leads to epithelial abrasion and slight leakage of urine into the deeper

As a result of this, inflammatory action is excited, and acts as a barrier to further escape into the tissues, the inflammatory new formation subsequently contracting and producing stricture.

Lecture II. is devoted to the pathology of the enlarged prostate and the treatment of some of the complications arising out of it. The prostate is here regarded as a sphincter muscle rather than a gland, the hypertrophy being a conservative

*The Lettsomian Lectures on some Points in the Surgery of the Urinary Organs. By Reginald Harrison, F.R.C.S. London: J. and A.

Churchill. 1888.