The author's experience has convinced him that division of the muscles of the back, in cases of spinal curvature, is scarcely ever of any use.

When speaking of the division of muscles to favour the reduction of old dislocations he refers to a case which had resisted all attempts at replacement, and which readily yielded after subcutaneous division of the tendons of the pectoralis major and teres minor.

After division of the tendon achilles on account of contraction, the result of paralysis of the extensor muscles, extension must be used with great caution. Directly after division the foot can be brought to a right angle, and the end of the tendon separated some inches, and if this is done the space becomes filled by exudation of blood, and union does not take place. Fourteen days should be allowed to pass in such cases before the extension apparatus is applied, and the cure is complete a few weeks later.

We find nothing more which is not fully noticed in our former articles, with the exception of a few remarks on habitual spasm of the flexor pollicis longior. Many persons much accustomed to the use of the pen are subject to spasms in the muscles of the thumb and index finger, and the influence of the will over the direction of the pen is lost for the time, and they write quite a different hand to their ordinary character. Their writing appears as if they had been in a shaky carriage on a bad road. With time the spasms become more severe and constant, and shaking of the fingers, which may be compared to stuttering, comes on; at a more advanced stage the pen can only be held by passing it through a cork, and after a time even this becomes too small to be held. In one case the pen had to be passed through a cork from three to four inches square, and this was inclosed by the whole hand. Usual remedies are of no avail, except long continued disuse of the pen. In one case a patient who did not take a pen in his hand for six months, at the first trial afterwards wrote with great With one sole exception the author has observed this condition in males only. He has practised tenotomy in such cases, but in only one was the cure perfect; in six others the state of things was the same after as before the operation. He divided the flexor pollicis brevis and longus, adductor pollicis, and the muscles of the index, according to the circumstances of the case, but without result. After the healing the spasms returned in the same degree, without any ill effect following, or the utility of the finger being much lessened.

ease.

NERVES. When we stated that the operative orthopedy concluded the volume, we had not observed a short chapter on the division of nerves. It is a very good one, giving a clear account of the experience of European surgeons, and taking a very unfavorable view of the operation under any circumstances. One case of the author, however, is interesting: very severe neuralgia had followed venesection; the injured nerve was divided, with instant effect, the pains, which had continued a month, immediately ceasing. A similar case is quoted from Hirsch, in which convulsions and coma accompanied local neuralgia, which were removed by two deep incisions over the wound. But whether for the relief of neuralgia, or tetanus, or for any other cause, success is rare; and "surgery is here under the greatest obligation to physiology, for pointing out that the sanguinary path is not the right one." The remedies the author has found most successful are the decoct. Gittmanni, iodine, and the cod-liver oil ("thrancur.")

Our analysis of this important work is now concluded. That its arrangement is faulty, and that for a complete system of operative surgery it is in many particulars defective, cannot be denied; still, in the departments of plastic surgery and tenotomy, it is by far the best work extant. The style is generally clear and forcible, and the descriptive portions, particularly when treating of the sufferings of patients or the results of operations, often border on the poetical. Still, in the description of many of the more delicate operations, the want of woodcuts in illustration is painfully felt. In more than one instance we had vainly endeavoured to satisfy ourselves that we had exactly comprehended the directions laid down, and in such cases have given a literal translation rather than a paraphrase, that we might not run the risk of misinterpretation. We would strongly advise the publication of a series of diagrams with the second volume, illustrating not only the operations to be there described, but also those included in the volume before us; the value of the work would then be greatly increased, and the student's task much facilitated.

Two courses were open to us in the composition of the preceding article: the one, to confine our attention to a very few subjects, and treat them fully by copious extracts and critical remarks; the other, to endeavour to give a general outline of the contents of the work before us, and a condensed account of its most important or new contents. We have adopted the latter, as likely to be the more useful; and as the work must become one of standard surgical reference, we shall hereafter have occasion to refer to it, when commenting on other works treating on any of the subjects we here have glanced over. To those who think we might have followed both courses, we would remark that it is not easy to condense eight or nine hundred pages of Dieffenbach's into forty or fifty of our own. This difficulty, however, is a test of the value of the work. We could point out effusions of similar extent in our own tongue, on which a single page would be fruitlessly expended. If writers would follow the example of our author, and keep silent until they had something valuable to communicate, much of the critic's task would be spared. It now only remains for us, in the name of our operating brethren, to return most cordial thanks to the veteran professor of Berlin for this most valuable contribution to the literature of our profession.

ART. II.

1. Second Report of the Commissioners for inquiring into the State of Large Towns and Populous Districts. 2 vols. 8vo.

2. A Bill for the Improvement of the Sewerage and Drainage of Towns and Populous Districts, and for making Provision for an ample Supply of Water, and for otherwise promoting the Health and Convenience of the Inhabitants.

I. REPORT OF THE COMMISSIONERS. In this, their second report, the commissioners observe, that until the publication of the reports made to the Poor Law commissioners in 1839 upon the condition of the poorer classes of her Majesty's subjects in certain parts of the metropolis, fol

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lowed by the report of a Select Committee of the House of Commons, in the year 1840, "on the Health of Large Towns and Populous Districts," the extensive injury to the public health, now proved to arise from causes capable of removal, appears to have escaped general observation, while the means of remedying the evils by improvements in drainage, or by other structural arrangements, as have been carried into operation, have been executed more with a view to the appearance of the town or the comfort of a portion of the inhabitants, than directed to maintain the health of the whole community. They also state that subsequent investigations and reports have excited increased attention to the importance of providing for the physical condition of the poorer inhabitants of large towns. The wealthy and intelligent classes resident in them are now for the most part becoming alive to this great question, and to the necessity of providing for the removal of those causes which tend to vitiate the air in the quarters occupied by the poor, and especially in those most densely crowded.

There can be no doubt that the course of inquiry the commissioners adopted for obtaining information was eminently judicious, and has mainly led to these results. By calling to their aid the assistance of the most influential and intelligent of the inhabitants, through whose means and local knowledge the peculiar conditions of many localities were closely investigated, scenes of misery and neglect were exposed to their view, of which many were previously ignorant, and their attention directed to causes of disease, arising from the defective state or absence of proper structural arrangements.

The necessity and utility of sanitary arrangements for towns is by no means a new topic of discussion within the profession. Even the idea of making the refuse of towns serviceable to agriculture, and a source of wealth to the country (developed by Mr. Smith, of Deanstown, in his report on York and other towns), was broached so early as 1798. In the second number of the American Medical Repository' of that year, Dr. Mitchell proposed, "to convert the mass of nuisance, which we now are with such happy success engaged in removing from the city of New York, by the powers of vegetation, from poison to wholesome articles of food." His plan was, that lime, potass, and soda, should be thrown about the streets to neutralise the emanations, and make the refuse more efficacious as manure. In 1802, the question of town drainage was again mooted in the United States and England. In that year, Dr. Patterson, of Londonderry, thus writes to the editor of the 'London Medical and Physical Journal:' "Perhaps some of the readers of the Medical Journal may be able to give an instructive answer to the following question, asked by Dr. Miller, of New York: Can you direct me to any source of full and satisfactory information concerning the best method of discharging from cities the filth of animal and vegetable kinds constantly accumulating in them, and espe cially the filth of privies? We are endeavouring to make some improvements of this description in New York, and wish to be instructed and assisted by the wisdom and experience of older cities.' Give me leave, on this occasion," adds Dr. Patterson, in the language of the day, "to second this wish of Dr. Miller, and to interest on this occasion your ingenious and philanthropic correspondents." Either the editors had no correspondents of the required description, or more probably their ingenuity and philan

thropy were not equal to the emergency, for Dr. Patterson's appeal met with no response.

We believe that, although there was a general impression on the minds of professional men as to the noxiousness of emanations from putrid or decaying animal or vegetable matter, less specific information was possessed by them, previously to the appearance of Mr. Chadwick's famous report, than the majority would willingly allow. Stinks on a small scale were unnoticed; they crept through the net of professional criticism. Stinks on a large scale were adjudged offenders, but were too great to grapple with, and were passed over with a shake of the head and a solemn protest. Formerly the judgment of the public was not enlightened; consequently the appeals of the profession to the dull and ignorant authorities might as well have been made to a statue of Memnon. It is by the active collection and diligent diffusion of information on matters relating to the public health, that the Health of Towns' Commission have done such good and lasting service to the public.

As the subjects specified in her Majesty's commission were essentially of a practical character, the commissioners have endeavoured to avoid as far as possible the discussion of the theoretical causes of disease. All the medical witnesses examined before them are unanimous as to the injurious effects produced by emanations from animal or vegetable matter in a state of decay, whether they act as direct or contingent causes of disease; and they are quite concurrent in their opinion that the existence of such causes and their prevalence have been sufficiently ascertained to require the interference of the legislature. The presence of such emanations, whether they be derived from stagnant ditches, from open cesspools, or from accumulations of decaying refuse, is a great cause of disease and death, not confined to the immediate district in which they occur, but extending their influence to neighbouring and even distant places.

It is too commonly supposed, the commissioners observe, that the evils above adverted to are the inseparable concomitants of poverty; and doubtless, so long as the inhabitants of the most neglected and filthy abodes in crowded cities are unable to provide for themselves better and healthier dwellings, sufficient light and air, more open situations, effective cleansing and drainage, and adequate supplies of water, their vigour and health are undermined, and their lives shortened by the deleterious external influence consequent upon the want of efficient arrangements for securing the above objects.

The commissioners farther advance, as a result of their inquiries, that other diseases besides fevers, namely, scrofula and consumption, are developed by injurious emanations and impure air; that the ascertained excess of deaths amongst artisans is in a great degree due to the defective ventilation of their places of labour; that the crowded and impure courts are distinguished by a high infantile mortality, and an increased proportion of births; and that many of the pecuniary embarrassments and much of the wretchedness and moral degradation of the poor may be traced to the physical degradation consequent on the neglect of hygienic measures. One of the facts which came to their knowledge, although not within the terms of their commission, they express themselves as bound to report on; it is the "terrible practice," as they term it, of giving opiates to children;

terrible because it induces not only death in its victims, but mental debility and imbecility in those who survive the administration of the narcotic.

The following is a short outline of the measures they propose to be adopted: their main reasons for these will follow.

"We are of opinion that, for the effectual correction of the evils above adverted to, additional legislative measures are requisite. It is necessary that the Crown should have power to inspect and supervise the execution of all general measures for the sanatory regulation of large towns and populous districts.

"That the local authorities entrusted with the execution of such measures should be armed with additional powers, and that the districts placed under their jurisdiction should in many cases be enlarged, and made coextensive with the natural areas for drainage.

"We recommend that the necessary arrangement for drainage, paving, cleansing, and an ample supply of water (the most important matters conducive to health) should be placed under one administrative body.

"We also urge the necessity of some general sanatory regulations relative to buildings and the width of streets, and that low lodging houses should be placed under public inspection and control.” (p. 11.)

It is a remarkable circumstance that most serious attention was given to works of drainage from the earliest periods of our constitutional history. The earliest fundamental provisions have been based upon the footing that such works, as well as measures for the maintenance of the free flow of running waters, were of general public and national, rather than of exclusively local, consideration. It is held, by the first legal authorities, to be one of the prerogatives of the Crown to issue commissions for the protection of the population, by the enforcement of proper works of drainage, and this prerogative appears to have been exercised by the issue of special commissions, as well after as before the passing of statutory provisions on the subject. The intervention of the Crown was often urgently sought for the public protection against the injurious encroachments of private interests upon the great public watercourses for mill power or for fishing-weirs. The 16th chapter of Magna Charta is a defence of the public rights against the growth of such encroachments. The fourth statute of the 25 Edw. III, c. 4, provides for the putting down of mills, weirs, dams, and other obstructions, and commissions appear to have been issued from time to time to see to the execution of the laws provided thereon. The commissioners give numerous examples of royal commissions for these purposes, and note the various modifications they have undergone from time to time until absorbed in modern legislation.

The inefficiency of modern, and especially local acts, seems to be partly due to the uncertain tenure by which the authorities hold office, partly to local influence, and partly to inefficiency of the powers given by law. It appears that ignorance of the authorities, (usually tradesmen, merchants, or lawyers,) has also been no trifling impediment to improvement.

The first and most important step, the commissioners observe, in providing for the efficient and economical execution of any plan of drainage, is the preparation of an accurate general survey, upon a large scale, of the area which it is proposed to drain. This view is supported by a large mass of valuable and important testimony, proving it to be the necessary preliminary to any such work. The extent of country to be comprised