vided sternal extremities of the ribs, which with the sternum form at first a common cartilaginous mass or rib plate.

The monograph is enriched with thirty plates on stone, containing no less than 508 separate drawings, all made from Mr. Parker's own original dissections and drawings. They are most clearly represented, the nature of the tissue being easily distinguished by the colouring and the markings in the lithograph, dots, striæ, &c. All credit is due to the Council of the Ray Society for publishing so valuable a work at so cheap a rate; but it ought to be stated that the Royal Society granted a hundred pounds towards the expenses of the plates.

ART. XII-On the Immediate Treatment of Stricture of the Urethra by the Employment of the "Stricture Dilator." By BARNARD HOLT, &c. Third Edition. London, 1868. Pp. 136.

THE method of treating obstinate stricture by forcible dilatation is one which has long engaged the attention of surgeons, and various apparatus have been devised for carrying it out, of which those which go by the names of Wakley, Maisonneuve, and Holt, are most widely known. Mr. Holt introduced his plan to the profession in London in the year 1861. It must have been well received, since he has now to publish a third edition of his treatise, and Mr. Holt's own experience of it must be allowed to be sufficient, since he tells us he has operated in 670 cases! There is one rather remarkable circumstance connected with this work of Mr. Holt, which, though it is not perhaps essential to the formation of a surgical judgment on the plan of treatment, yet surely deserves more distinct mention than Mr. Holt has thought proper, as far as we can see, to give it-we mean the originality of the proposal. Mr. Holt certainly in his first edition, denominated his instrument "A new stricture-dilator ;" and he applies the same term to it still, on P. 4 of the present edition. But it was soon stated by Sir H. Thompson and others, that this instrument bore a great resemblance to one introduced into practice by Perrève in the year 1847; and Mr. B. Wills Richardson, of Dublin, has reproduced Perrève's figures side by side with Mr. Holt's, in order to show that the "new stricture dilator" could really be made from Perrève's drawings; that, in fact, Mr. Holt's proposal is an entire plagiarism, down to its minutest details. Mr. Holt attempted to show that there was some essential difference

1 Holmes's 'System of Surgery,' iv, 398.

between his dilator and Perrève's; but the only effect of this was to provoke his assailant to prove, beyond all possibility of doubt, that this was not so, and that any instrument maker could have made the one from the drawings of the other. Still

Mr. Holt continues to consider himself as the inventor of the method, and all that we can find on the subject of his own originality in this edition is the following rather curious paragraph (p. 127).

"In conclusion, I may add, that in advocating the treatment of stricture by rupture, I claim simply that credit which attaches to the publication of a series of interesting cases (examples of many others) which have been subjected to this novel treatment. That the principle upon which the instrument is constructed is as old as the hills, and that the power of the wedge has been known as long as the simplest rules of mechanics have been taught, I freely admit, but I have yet to learn that that principle has been heretofore applied to the treatment of stricture of the urethra in the manner detailed above, and with such highly satisfactory results."

This is hardly an answer to the charge that Mr. Holt knowingly adopted all the details of Perrève's invention and passed them off on the public as his own, without mentioning Perrève's name in any of his three editions. The plain fact is, that if Mr. Holt was acquainted with Perrève's book before writing his own, he ought to have acknowledged his obligation to the French surgeon; if, on the contrary, so remarkable a coincidence of invention took place without any previous knowledge on his part part of his predecessor's labours, Mr. Holt ought in justice to his own character to have distinctly asserted it.

We gladly leave this personal question, which however touches too nearly the character of English surgery to be altogether passed over. Apart from the originality of the proposal what is its merit? Mr. Holt has contributed an abundance of successfu. cases in detail in this volume. He has operated on the enormous number of 670 cases, and the operations have all been successful except two, the details of which are given. The experience also of other surgeons has abundantly shown that the operation is very often most successful, and affords an amount of relief in a period of time, and with an immunity from risk, which no other operation can promise. Besides, further experience has shown, that the stricture is not (in many cases at any rate) really ruptured, but only dilated, and therefore there is no risk of extravasation of urine, or of septic poisoning from the pangs of inflamed urine over a raw surface. The following observations (pp. 96-98) are of much interest:

"Since the above was written, a very interesting essay, for the

Fellowship of the Royal College of Surgeons by examination, On Organic Stricture of the Urethra, and its Treatment by Holt's Method,' has been published by Dr. Millar, of Edinburgh, in which he records the post-mortem appearances of the urethra of a patient upon whom he operated nineteen days prior to his death, occasioned by obstruction of the bowels; and after detailing the appearance of the intestine, he says: The bladder and urethra were removed. In so doing, an abscess, probably connected with Cowper's glands, and lying close upon the membranous portion of the urethra, was opened into. The bladder was hypertrophied, and the mucous membrane thickened, as is usual in cases of long-standing stricture. The urethra, on being cut open, was without a trace of rupture or cicatrix (ride plate). The membranous portion was attenuated, owing to the abscess formerly mentioned. A preparation was made of the bladder and urethra, which I had the honour of showing before the Medical and Chirurgical Society in December last.' And another very remarkable case was about the same time recorded by Dr. M'Donnell, of Dublin, in his paper On the Treatment of Stricture by the Stricture Dilator,' of a patient who died from cholera, and in whom the immediate operation had been performed fifteen days prior to his death. Dr. M'Donnell removed the bladder and urethra, and they were examined carefully by Dr. Cruise, Mr. William Stokes, and himself, soon after removal. The appearance, however, at that time was not materially different from what the members had now an opportunity of seeing. A No. 9 catheter could readily be passed along the urethra. Except for the hypertrophied condition of the muscular. coat of the bladder, and the dilated state of the portion of the urethra behind where the stricture had been, there was no other sign of the disease having existed.

"Dr. Millar has also referred to three cases, published in my 'Opinions and Statistics on the Immediate Treatment,' where the parts were examined shortly after death, and where the mucous membrane was found to be entire, and arguing upon these facts, and the examination of numerous preparations, he infers that in most cases the mucous membrane is not torn at all, but that the deposit of lymph in the submucous tissue around the canal is alone ruptured."

Thus it appears that the lesion is much less and the operation is much safer than was at first supposed. The question remains, is the treatment desirable? We have Mr. Holt's assurance that he has operated on 670 cases-420 since the publication of his second edition. This would seem to show that he has operated on every case of stricture which has come into his hands. If so, can this be good practice? Our own experience of Mr. Holt's operation is very restricted, since we have always confined operative treatment to cases presenting some peculiarity; but we have observed occasionally very severe and apparently cicatricial recontraction when the stricture has been neglected (as patients

will do in spite of every warning), after forcible dilatation; and we confess to considerable incredulity as to the applicability of Dr. M'Donnell's and Dr. Millar's explanation to the severer forms of stricture and to traumatic strictures above all others. In these tougher cases we have little doubt that rupture is actually produced. In all cases there is certainly some danger of it, if there is any real obstruction present; and experience has shown that death or alarming symptoms sometimes, though rarely, follow the operation. We have no hesitation, therefore, in expressing a strong opinion that the operation performed in this indiscriminate fashion is a mistake. Used with judgment, and on properly selected cases, we believe it to be one of great value; and we hold that Mr. Holt, by introducing it to the notice of the profession in England, has done us a real service, and is deserving of the highest credit if he is really original in the matter.

very

ART. XIII.-1. Berättelse afgifven till Kgl. Sundhets-Kollegium om den Medikopneumatiska Anstaltens verksamhet i Stockholm under åren 1863 och 1864. Af Dr. OSCAR THEODOR SANDAHL. Stockholm, P. A. Norstedt och Söner. 1865. 8vo, pp. 56.

Report presented to the Royal College of Health on the Operation of the Medico-pneumatic Institution in Stockholm during the Years 1863 and 1864. By Dr. OSCAR TH. SANDAHL. Stockholm, P. A. Norstedt and Sons.

2. Nyare undersökningar och iakttagelser rörande de fysiologiska och terapeutiska verkningarne af bad i förtätad luft. Meddelade af Dr. OSKAR TH. SANDAHL (Aftryck ur Hygiea'). Stockholm. 1865. 8vo, pp. 35.

Recent Investigations and Observations respecting the Physiological and Therapeutical effects of Bathing in Condensed Air. Communicated by Dr. OSCAR TH. SANDAHL (reprinted from the Hygiea'). Stockholm. 1865.

3. Des Bains d'Air Comprimé: court Aperçu de leurs Effets Physiologiques et Thérapeutiques; précédé d'une description de l'établissement médico-pneumatique de Stockholm. Par OSKAR TH. SANDAHL, Docteur en Médecine et en Chirurgie, Professor Agrégé à l'École de Médecine de Stockholm. Stockholm. 1867. Pp. 60, with two plates.

Baths of Compressed Air: a short Sketch of their Physiological and Therapeutical Effects; preceded by a Description of the Medico-pneumatic Establishment at Stockholm. By OSCAR TH. SANDAHL, Doctor in Medicine and Surgery, Joint Professor in the School of Medicine, Stockholm.

In the above list we have arranged the three works of Dr. Sandahl, now brought before us, in chronological order; but as the third is a translation of the second, with the advantage of revision by the author, after two years' additional experience, we shall, in the present notice, in the first instance, place before our readers a summary of its contents, concluding with such remarks as may be suggested to us by the facts recorded in the report of the Medico-Pneumatic Institution in Stockholm, which stands at the head of our list.

According to the author, it is about thirty years since baths of compressed air were first employed in a rational manner. It is to M. Emile Tabarié, of Montpellier, that we are indebted for the first trial of this new remedy. Since that time their employment has spread widely. Medico-pneumatic institutions have been established at Montpellier, Lyons, and Nice; Stockholm, Gothenburg, and Upsala; Helsingfors; Copenhagen; Berlin, Doboeran, Dresden, Leipsic, Hanover, Nassau, Ems, Johannisberg, Wiesbaden, Frankfort-on-the-Maine, Stutgardt, Reichenhall, Vienna; in London; and at Petersburgh. The bibliography of the subject, of which a full catalogue is given by Dr. Sandahl, is already tolerably extensive.

The establishment in Stockholm was opened on the 10th October, 1860, and on the 1st April, 1866, it was found necessary, in consequence of the increase in the number of patients, to transfer it to a more roomy locality. It now consists of a large hall for the receivers, and of five chambers (two for the inhalation of pulverised medicaments, two little waiting rooms for patients, and one in which the mechanist of the establishment lives), with antechamber, all situated on the ground floor, and communicating with the underground chamber, in which the steam-engine and the pump for compressing the atmospheric air work.

The duration of the sittings is from one to two hours. The increase of pressure is usually from one quarter to one half atmosphere. A library is provided for those who wish to read during the sittings.

The physiological effects of compressed air are said to be as follow:

I. Effects on respiration.-1. The force of the respiratory muscles is increased. 2. The vital capacity of the lungs is