and two were very little benefited. Seven died from the direct results of the operation, one of whom was in a dying state when it was performed, and five of pyæmia, which seems then to have been prevalent at the Children's Hospital. The remaining three cases died some time after the observation; one from independent disease, the other two from long-continued suppuration.

These, as Mr. Holmes very fairly allows, are not satisfactory results; but, considering the ordinarily long duration of the disease, and the hopelessness of a natural cure in poor children once the bones have become carious, they imply that the operation will often be advisable merely to save life, while the limb is far more mobile after a successful excision than after spon

taneous cure.

With regard to the vexed question of excision of the knee, our author is of opinion that it is a more severe operation than amputation, being both more immediately dangerous to life and requiring a longer time for convalescence. It is, therefore, only to be recommended in the most favorable cases, in which it has over amputation the great advantages of leaving a useful limb instead of a stump.

We have dwelt so long on this subject that we have no space to give an account of the important suggestions made by our author for the various operations in disease of the tarsal joints, but we regret this the less that we hope what we have already said will induce every practical surgeon to study the book for himself. We would especially call attention to the chapters on infantile prolapsus, hernia, and stone. The highest praise we can give them is that they are fully equal in merit to the rest of the volume.

Mr. Holmes is unable to find room in his volume for dis

eases of the eye; if any special account of these is desired, probably none can be found better than that given by M. Giraldès, in the lectures which stand last upon our list. As these are still unfinished, it would be unfair to say more in the way of criticism than that they are, perhaps, too clinical. Being the exact reproduction of the lecturer's words, the con tinuity necessary in a book is constantly broken by digressions to cases of a totally different kind, under treatment at the same time. Besides diseases of the eye, hydrocephalus, harelip, hydatid cysts of the liver, ovarian and myeloid tumours, are the principal subjects treated of, and all of them in a way that is thoroughly practical and interesting. When finished, these lectures will probably form a complete course of infantile surgery, worthy of the successor of Guersant, and of the unrivalled means of observation at M. Giraldès' disposal.

REVIEW VIII.

1. A Manual of the Principles of Surgery, based on Pathology, for Students. By WILLIAM CANNIFF, Licentiate of the Medical Board of Upper Canada; M.D. of the University of New York; M.R.C.S. England, &c. Philadelphia, 1866. Pp. 402.

2. Conservative Surgery, as exhibited in remedying some of the Mechanical Causes that operate injuriously both in Health and Disease. By HENRY G. DAVIS, M.D., Member of the American Medical Association, &c. New York, 1867. Pp. 315.

3. A Practical Treatise on Surgical Apparatus, Appliances, and Elementary Operations. By PHILIP S. WALES, M.D., Surgeon U.S.N. With 642 Illustrations. With 642 Illustrations. Philadelphia, 1867. Pp. 685.

4. Plastics: a new Classification and a Brief Exposition of Plastic Surgery. By DAVID PRINCE, M.D. Philadelphia, 1868. Pp. 93.

THE books which we have grouped together in this article are all of American origin, and they well illustrate the eminently practical character of the American mind. They deal with a variety of subjects in surgery, as it is at present practised, and supply us with some valuable suggestions; but they hardly touch upon any questions of theory. Our American brethren have singular advantages for the pursuit of medical and surgical inquiries. They have a country so vast that it presents the most different climatic and hygienic conditions; they are brought in contact with a variety of races; and the recent war has supplied them with an amount of experience and with a mass of statistics which can hardly fail to prove of service to science. And it must be admitted that the American surgeons have made a good use of their opportunities, for they have given us some valuable additions to the practice of surgery, and have helped to advance this department of knowledge in a notable degree.

In reading these books one can hardly fail to be struck-and not a little flattered-by the frequent references which are made to our professional literature, and the weight and authority which are allowed to the opinions of English surgeons.

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Thus, if we turn to the first, The Principles of Surgery, based on Pathology,' we must admit that the author is cer

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tainly very candid, for in his preface he gives a list of German and English works which he has "freely consulted;" and as we read through his pages we see that he has not over stated the use that he has made of them. We find scattered throughout his whole work long quotations from Paget's 'Lectures on Surgical Pathology,' Virchow's Cellular Pathology,' and Holmes's System of Surgery,' besides many shorter passages extracted from other authors. Moreover, the whole of his illustrations are taken from Mr. Paget's Lectures; so that we are thus furnished with a very good skeleton for a work upon 'Surgery, based on Pathology.' It needs only that the extracts from standard authors should be carefully selected, and that the woodcuts should be used with judgment, in order to make a trustworthy Manual of the Principles of Surgery.' And this much praise we may certainly accord to our author. If there is nothing original in his work, and if his quotations appear to us to be taken with rather too free a hand from the writings of others, at any rate he deserves the credit of having pieced them together so as to form a useful and readable book.

The writer is a Canadian, and, as he tells us in his preface, his grandfathers and his father were pioneers in the wilderness of Canada, so that he himself did not enjoy the advantages of early literary training. It is only fair that we should bear this in mind, for the volume before us certainly reflects credit upon. the energy and industry of the author. He appears to have received his medical education partly in this country and partly in the United States; and he has evidently made a good use of the extensive opportunities for observation which he has had both in Europe and America. He has served as a military surgeon with British troops and with the United States army; and perhaps the most interesting part of his book-the only part indeed which has any novelty about it-consists of his experiences during the recent civil war in America. The chapters upon gunshot wounds are those that we have read with the greatest pleasure, because they are almost the only ones which have an air of freshness. In most of the others we are sensible that we are perusing what we have read elsewhere, and the occurrence of the well-known illustrations from Mr. Paget's Lectures helps to confirm the fact.

On the question, How far an alien race can flourish in a country to which they do not originally belong, our author makes the following remarks. They are intended to supply an answer to the theory that colonising races will inevitably die out, unless they are constantly recruited by fresh emigrants from the mother country. Upon this subject Mr. Canniff's opinion may be allowed to have weight, for he has himself been

brought up among the descendants of English and French emigrants in Canada, and he has subsequently had opportunities of comparing the colonists with the European races from which they have sprung.

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"The French of Lower Canada, even under many adverse circumstances, have fully retained their ancient bodily vigour, and can compare favorably with the present inhabitants of old France, while their number has increased; yet their ancestors, many of them, emigrated to New France 200 years ago; and, since the colony became a part of Britain, no replenishment' has been received from the old stock. Turning to Upper Canada, we find a fact no less important, and quite as antagonistic to the theory that native Americans are doomed to die out. In consequence of the American revolutionary war, some 25,000 or 30,000 united empire loyalists were forced or induced to seek a home in the Canadian wilderness. Many of these were descendants of those who had first peopled New Holland along the banks of the Hudson. A large number of these limited empire loyalists settled along the St. Lawrence and the Bay of Quinte. In the main, indeed, almost altogether, until very recently, these old settlers have intermarried. Now and then an emigrant might settle among them, but it was an exception. The great grandchildren of those American pioneers now live on the old homestead, and are found scattered over the whole province; and although I have no positive data upon which to base my assertion; yet, from careful observation, I have no hesitation in declaring that in physical development, in slight mortality among the children, in length of life, in powers of endurance, not to say in bravery and patriotism, they cannot be excelled by any class of emigrants."P. 141.

The next extract that we shall offer to our readers is intended to show the value of veratrum viride as a vascular sedative and antiphlogistic. The American evidence in favour of this drug. seems to indicate that it deserves a more extensive trial than it has yet had in this country. The tendency of medical practice of late years has been so much opposed to anything like active antiphlogistic treatment, that we have perhaps failed to give the veratrum viride a fair trial. However this may be, here is our author's testimony in its favour, and very strong testimony it is.

"Veratrum viride is a medicine which does not enjoy the long established reputation which belongs to antimony; but it successfully rivals that drug as a powerful antiphlogistic. I have found it particularly useful in inflammation of the lungs. Two cases of such, which were also most interesting in a surgical point of view, I will particularly refer to. These were cases under my immediate care in Lincoln Hospital, at Washington. Both came in at the same time, direct from the battle-field. The first one which

engaged my attention was unable to lie down, but had to sit leaning forward considerably. His efforts to breathe were most urgent. He could barely tell me that he was wounded in the chest-that the ball had passed through his body. I hastily looked at the wound in front, which was the place of entrance; it was between the fifth and sixth ribs, on right side of and very near to the sternum. I not only considered his case hopeless, but thought he could not live an hour. I ordered him a draught of compound spirits of ether, which was shortly repeated. In half an hour he went to sleep, his head resting forward on a chair, made somewhat comfortable for the head. He slept for two hours or more. During the sleep and on waking he could breathe a little more easily. I examined the wound posteriorly, and found that the ball had passed almost directly backwards, and had made its escape. It was now some thirty hours since the reception of the wound. The action of the heart was laboured, and there was some fever; the skin was hot and dry. I put him on veratrum viride, to be given often, in small drop doses. I had every reason to believe, from the symptoms, which I cannot here fully describe, that the ball had passed through the lung. It was several days before the patient could lie down. Symptoms of pneumonia presented themselves, but were kept under control, and finally the patient became convalescent.

"The other patient was also wounded with a ball, which had struck the right clavicle at about its middle, and, shattering the bone, had buried itself in the part. In this case, also, there were well-marked signs of the lung being wounded. At first the distress was not great, the dyspnoea but little; in two days, however, it was very great. He was ordered the veratrum viride every three hours. I found it unnecessary to give anything else. In a few days the symptoms of inflammation subsided. Because of the important structures immediately beneath the clavicle, the ball was but slightly searched for. When the patient passed from under my care, his condition was most promising. The wound remained from open, which was a little purulent discharge, which might have been due to the necrosed state of a part of the clavicle. Now, both of these men were young and full of healthy blood; but neither general nor local bleeding was deemed necessary. The inflammation was successfully treated solely by the veratrum viride."-P. 87.

We have already said that some of the best chapters in the volume before us are those which relate to gunshot wounds, and that some of the most interesting passages are Mr. Canniff's experiences during the late conflict in the United States. In speaking of the strange course which a bullet will sometimes take, he says

"One case which I saw after the battle of Chancellorsville will serve to illustrate the extraordinary direction the ball may take. A private of one of the New Jersey regiments had been wounded in the right arm, while in the act of putting a cartridge into his musket.