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888 habit of speaking of it as antiphlogistic, in contrast with antiseptic, but some of my friends have suggested that possibly it is antiseptic as well. Although the above is the chief point, yet there are otheI minor matters which are probably of some importance as conducive to success, and which, although they are all of them well known to operators, I may perhaps ’be excused for mentioning. No blood should be left in the wound, nox should there be any risk of bleeding. Far better wait an hour or two than put up a wound prematurely. A drain. age tube left in the most depending part of the wound is usually a safe precaution. In the case of removal of a breast I always make a counter-opening at the most depending part and put the drainage-tube through this. It should be removed on the third day. I have no fear of either sutures or ligatures, but always tie with silk every bleeding vessel, and coapt the edges very carefully with numerous stitches. Great care should bE taken that none of the latter are tight, and they should all be taken out on the third or fourth day. If the wound bE prevented from inflaming there will be no suppuration about either sutures or ligatures, and often these will re main perfectly dry. After the sutures, strips of plaster with narrow intervals, should be carefully applied, and these should remain on for five or six days. Over the plaster, I always apply a lint compress wet with the lotion, and over this a mass of cotton wool, which is kept in placE pretty tightly by a flannel bandage. This is applied tc prevent oozing, and, as already said, is to be taken quit( away in from six to twelve hours. Of course if there is any tension on the edges of the wound union by first intention can scarcely be hoped for, and ever3 endeavour should be made to secure easy coaptation. If il be a matter of necessity to leave part of the wound open the lead lotion may be still used, and is yet more necessary I have never witnessed any ill results from absorption o: lead, and I feel confident that in many cases of open wound: so treated diffuse inflammation has been prevented. If, in spite of precautions, blood-clot has accumulated ii the wound, or if suppuration has occurred, then at once cut the sutures freely and reopen the wound. Syringe the wound out or not as may seem desirable, but on no accoun desist from the lead-lotion. In concluding this short paper, I feel that the simplicity of the recommendation almost calls for an apology to th reader. I am hopeful, however, that those who will try i will not consider that it needs one on any other ground. Cavendish-square, W. Reviews and Notices of Books. lectures on Skin Diseases. By E. D. MAPOTHER, M.D, Professor at the Royal College of Surgeons, Ireland, latE Examiner in Surgery at the Queen’s University, &c. With Illustrations. Second Edition. Dublin: Fannin and Co London: Longman and Co. Edinburgh: Maclachlai and Stewart. 1875. OUR opinion against the increase of specialism, ani especially against the narrow specialty of dermatology, is so well known that it will not be matter of surprise if W4 confess it was with great pleasure that we received from th4 hands of a highly-esteemed Irish surgeon these lectures 01 Skin Diseases. In recent times general physicians and surgeons have shown a too ready disposition to allow the claims of the self-elected specialists. Without demur, the ear, the nose the mouth, the throat-in fact, every portion of the bod has been divided and subdivided into the smallest areas each of which has been handed over to the care of one se of practitioners or another, and not always to the best edu cated or the most skilful of practitioners. It is, indeed but too true that the great body of specialists is compose’ largely of those who are intellectually quite incapable o comprehending all the departments of the healing art. The; succeed only by limiting their sphere of action ; the; triumphantly paddle in pools who would not live on moment in the stream. With the exception of ophthalmo- logists, specialists cannot, as a rule, be said to be among the best educated of the profession; and, worse than all, the exclusive practice of some small specialty tends to per- petuate and increase ignorance, if it do not also deprave professional morals. Be this as it may, we are always ready to welcome works on special subjects from general physicians and surgeons.. Nor is the work thus produced altogether without value or commendation if in some respects it is wanting in the more minute details of the special subject of which it treats. The principle is a good one, and ought to be encouraged. On the other hand, the fact that the special work is written by one engaged in general practice should not allow us to close our eyes to faults that are avoidable, for if a general phy- sician or surgeon venture to write a work on a special subject he must be prepared to stand or fall on his own merits, and must submit to the test of fair criticism, and not expect to escape just censure. Although, therefore, some consideration should be shown to the general physician or surgeon writing on a special subject, the work itself must be judged by ordinary standards. If we take this ground, we shall have to confess that, creditable as these lecture. before us on skin diseases doubtless were as oral discourses, they fall far short of what a book on skin diseases ought in our opinion to be. As lectures delivered in the ordinary course of clinical instruction, we can readily imagine they were interesting and instructive, but as lectures they should have remained. For his own sake, we regret that Dr. Mapother should have yielded to the seductive request of his pupils to submit them to publication. But seeing that the work is published we are compelled, unwillingly it ia true, to direct some attention to its failings and short- comings. Let us consider, first, what is, after all, the most essential element in the work-namely, the subject-matter. In the opening chapter on Parasitic Diseases, many of the views entertained by Dr. Mapother are, to say the least, anti- quated, and not a few are distinctly erroneous. After stating that the pediculus corporis 91 is now believed to be the cause of that dreadful disease, prurigo," Dr. Mapother joyfully exclaims, " This is, after all, a most satisfactory condition," for ten years ago it was ’° taught that the dis- ease was often incurable." To anyone acquainted with the true disease prurigo, this confusion of prurigo and phtheiriasis must appear unpardonable. The characters of the two diseases are quite distinct and separate, and cannot usually be confounded, except through carelessness or ignorance. The small hsemorrhagic speck just within the mouth of the follicle-not own the follicle, as Dr. Mapother states-is rarely, if ever, absent in phtheiriasis; while the appearance of the skin, the course of the disease, and the situation of the eruption are sufficiently characteristic of true prurigo. Among parasitic diseases also is described sycosis; but from the account given it is difficult to deter- mine whether Dr. Mapother regards sycosis as parasitic or not. If he do regard it as parasitic, it is not a little startling to read, just after the statement that the disease- is probably due to some fungus, that Mr. Hutchinson has drawn attention to the similarity between sycosis and hordeolum, or stye. The second lecture treats of Erysipelas, Erythema, Urti- caria, Herpes, Impetigo, Pemphigus, &c., and is perhaps the best chapter in the book, erysipelas being very well described. We imagine, however, that the experience of most dermatologists will hardly accord with that of Dr. Mapother when he states that the chronic or foliaceous variety of pemphigus is common, and is often met with in old, broken-down persons. Pemphigus foliaceus we have’

Reviews and Notices of Books

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888

habit of speaking of it as antiphlogistic, in contrast withantiseptic, but some of my friends have suggested thatpossibly it is antiseptic as well.Although the above is the chief point, yet there are otheI

minor matters which are probably of some importance asconducive to success, and which, although they are all ofthem well known to operators, I may perhaps ’be excusedfor mentioning. No blood should be left in the wound, noxshould there be any risk of bleeding. Far better wait anhour or two than put up a wound prematurely. A drain.age tube left in the most depending part of the woundis usually a safe precaution. In the case of removalof a breast I always make a counter-opening at themost depending part and put the drainage-tube throughthis. It should be removed on the third day. I haveno fear of either sutures or ligatures, but always tiewith silk every bleeding vessel, and coapt the edges verycarefully with numerous stitches. Great care should bEtaken that none of the latter are tight, and they should allbe taken out on the third or fourth day. If the wound bEprevented from inflaming there will be no suppurationabout either sutures or ligatures, and often these will remain perfectly dry. After the sutures, strips of plasterwith narrow intervals, should be carefully applied, andthese should remain on for five or six days. Over theplaster, I always apply a lint compress wet with the lotion,and over this a mass of cotton wool, which is kept in placEpretty tightly by a flannel bandage. This is applied tc

prevent oozing, and, as already said, is to be taken quit(away in from six to twelve hours.Of course if there is any tension on the edges of the wound

union by first intention can scarcely be hoped for, and ever3endeavour should be made to secure easy coaptation. If ilbe a matter of necessity to leave part of the wound openthe lead lotion may be still used, and is yet more necessaryI have never witnessed any ill results from absorption o:

lead, and I feel confident that in many cases of open wound:so treated diffuse inflammation has been prevented.

If, in spite of precautions, blood-clot has accumulated iithe wound, or if suppuration has occurred, then at oncecut the sutures freely and reopen the wound. Syringe thewound out or not as may seem desirable, but on no accoundesist from the lead-lotion.In concluding this short paper, I feel that the simplicity

of the recommendation almost calls for an apology to threader. I am hopeful, however, that those who will try iwill not consider that it needs one on any other ground.Cavendish-square, W.

Reviews and Notices of Books.lectures on Skin Diseases. By E. D. MAPOTHER, M.D,

Professor at the Royal College of Surgeons, Ireland, latEExaminer in Surgery at the Queen’s University, &c. WithIllustrations. Second Edition. Dublin: Fannin and CoLondon: Longman and Co. Edinburgh: Maclachlaiand Stewart. 1875.OUR opinion against the increase of specialism, ani

especially against the narrow specialty of dermatology, isso well known that it will not be matter of surprise if W4confess it was with great pleasure that we received from th4hands of a highly-esteemed Irish surgeon these lectures 01Skin Diseases.In recent times general physicians and surgeons have

shown a too ready disposition to allow the claims of theself-elected specialists. Without demur, the ear, the nosethe mouth, the throat-in fact, every portion of the bodhas been divided and subdivided into the smallest areaseach of which has been handed over to the care of one seof practitioners or another, and not always to the best educated or the most skilful of practitioners. It is, indeedbut too true that the great body of specialists is compose’largely of those who are intellectually quite incapable ocomprehending all the departments of the healing art. The;succeed only by limiting their sphere of action ; the;triumphantly paddle in pools who would not live on

moment in the stream. With the exception of ophthalmo-logists, specialists cannot, as a rule, be said to be amongthe best educated of the profession; and, worse than all,the exclusive practice of some small specialty tends to per-petuate and increase ignorance, if it do not also depraveprofessional morals.Be this as it may, we are always ready to welcome works

on special subjects from general physicians and surgeons..Nor is the work thus produced altogether without value orcommendation if in some respects it is wanting in the moreminute details of the special subject of which it treats. Theprinciple is a good one, and ought to be encouraged. On

the other hand, the fact that the special work is written byone engaged in general practice should not allow us to closeour eyes to faults that are avoidable, for if a general phy-sician or surgeon venture to write a work on a specialsubject he must be prepared to stand or fall on his ownmerits, and must submit to the test of fair criticism, andnot expect to escape just censure. Although, therefore,some consideration should be shown to the general physicianor surgeon writing on a special subject, the work itself mustbe judged by ordinary standards. If we take this ground,we shall have to confess that, creditable as these lecture.before us on skin diseases doubtless were as oral discourses,they fall far short of what a book on skin diseases ought inour opinion to be. As lectures delivered in the ordinarycourse of clinical instruction, we can readily imagine theywere interesting and instructive, but as lectures they shouldhave remained. For his own sake, we regret that Dr.Mapother should have yielded to the seductive request ofhis pupils to submit them to publication. But seeing thatthe work is published we are compelled, unwillingly it iatrue, to direct some attention to its failings and short-comings.

Let us consider, first, what is, after all, the most essentialelement in the work-namely, the subject-matter. In the

opening chapter on Parasitic Diseases, many of the viewsentertained by Dr. Mapother are, to say the least, anti-quated, and not a few are distinctly erroneous. After

stating that the pediculus corporis 91 is now believed to bethe cause of that dreadful disease, prurigo," Dr. Mapotherjoyfully exclaims, " This is, after all, a most satisfactorycondition," for ten years ago it was ’° taught that the dis-ease was often incurable." To anyone acquainted withthe true disease prurigo, this confusion of prurigo andphtheiriasis must appear unpardonable. The characters ofthe two diseases are quite distinct and separate, and cannotusually be confounded, except through carelessness or

ignorance. The small hsemorrhagic speck just within themouth of the follicle-not own the follicle, as Dr. Mapotherstates-is rarely, if ever, absent in phtheiriasis; while theappearance of the skin, the course of the disease, and the situation of the eruption are sufficiently characteristic oftrue prurigo. Among parasitic diseases also is described

sycosis; but from the account given it is difficult to deter-mine whether Dr. Mapother regards sycosis as parasiticor not. If he do regard it as parasitic, it is not a little

startling to read, just after the statement that the disease-is probably due to some fungus, that Mr. Hutchinson hasdrawn attention to the similarity between sycosis andhordeolum, or stye.The second lecture treats of Erysipelas, Erythema, Urti-

caria, Herpes, Impetigo, Pemphigus, &c., and is perhapsthe best chapter in the book, erysipelas being very welldescribed. We imagine, however, that the experience ofmost dermatologists will hardly accord with that of Dr.Mapother when he states that the chronic or foliaceousvariety of pemphigus is common, and is often met with inold, broken-down persons. Pemphigus foliaceus we have’

889

always looked upon as a rather rare disease, at all events inthis country.The lecture on Eczema is curious in many respects, but

in none more than in this, that the author claims to havediscovered THE cause of eczema-namely, gout, in supportof which he advances eight arguments, but which we neednot now repeat. In this chapter also it is alleged that thedeep-fissured condition of the palm of the hand, often calledpsoriasis palmaris, has more the features of eczema. In thisinstance Dr. Mapother is surely mixing up two distinct con.ditions-eczema of the palm and the desquamative affectionof the palm that follows the deposition of granulative tissuein the true skin, a deposition which necessarily interfereswith normal cuticular growth, and is always syphilitic.The third lecture, on Scaly Eruptions, is remarkably in-

volved. General psoriasis and pityriasis rubra seem to beconfounded. Pityriasis is stated to be often due to "a vegetal parasite, especially the form termed versicolor," andit is suggested that pityriasis rubra is 11 the same disease asthat described as foliaceous pemphigus," the author re-

ferring to one of the Sydenham Society’s plates in con.firmation of his fancy. A case of ichthyosis, " which is

exemplary in all particulars," is described, in which thEdisease did not show itself till the patient was forty yeareof age. This is certainly opposed to all experience, andjudging from the description given of the case, we shouldhave little hesitation in affirming that it was not ichthyosifat all. This doubt is, at least, only reasonable when a]*,

previous experience has gone to show that ichthyosis iE

a congenital condition. -

Passing by the fifth lecture, which might wisely ancprudently have been omitted, as it deals only with Purpura.Cerebro-spinal Meningitis, &c., which are certainly les!diseases of the skin than diseases of other parts of the bodywe come to the lecture on Syphilitic Skin AffeètioneAlmost at the outset we meet with the passage that " N(

peculiar rash (save, perhaps, rupia) is produced by syphilisall the anatomical varieties of eruptions we considered irthe previous lectures, arising from it." We have beercareful to reproduce this sentence in full, in order that thereader may not think we have misunderstood the authorTo say that any of the ordinary skin eruptions may be pro.duced by syphilis, although not strictly true, might have beerpassed over, but to state that there is no peculiar rash irsyphilis is incomprehensible. The fact is that there is n01a single skin manifestation of syphilis that is not peculia]to syphilis, and it is more than doubtful whether syphiliiever produces any ordinary skin disease. For ourselves WEshould allege that it never does-that is to say, that i1

is never the essential cause of any ordinary skin eruption.Lest it may be thought that we have been actuated b3

a too captious spirit, let us now state that for Dr. Mapotheras a physiologist, a surgeon, and a clinical teacher we hav<always had a very great respect, and still have. We shallindeed, be sorry if the remarks we have felt it our duty t(make on his Lectures on Skin Diseases should in any wa3lessen his interest and enthusiasm in the great and goodtutorial work in which he is now engaged. We aver thatwith these lectures as mere clinical lectures we should havffound no fault, but with them in their published form wehave but little sympathy, which is the more regrettable a!there is very strong evidence that most of the objectionablematter has been interpolated in preparing the lectures foithe press.

THE "Army and Navy Gazette" states that the WarOffice refuses to fill vacancies among the medical officers otMilitia regiments, it having been decided that medical aidduring the annual training of regiments shall be affordedby the members of the Army Medical Department.

THE

GENERAL COUNCIL OF MEDICALEDUCATION & REGISTRATION.

Session 1875.

THURSDAY, JUNE 17TH.AT the conclusion of the President’s opening address,

which we published at length in our last number, theBusiness and Finance Committees were reappointed ; Dr.A. Wood being chairman of the former, and Dr. Quain ofthe latter.On the motion of Dr. ANDREW WooD, it was resolved

that the communications made by the Executive Committeeto the Registrar-General, to the office of the Secretary ofState for the Home Department, and the Local GovernmentBoard, be entered on the Minutes. The first of these com-munications was a letter from the Registrar-General sub-mitting to the Council the new form of death certificate heproposed to issue, and asking for any suggestions. To thisthe President of the Council replied as follows :-

Medical Council Office, 315, Oxford-street, London,October 29th, 1874.

SJR,-I have the honour to inform you that one of theproof copies of the Book of Forms, with which you were80 good as to supply the Medical -Council, in answer to myapplication, has been forwarded to every member of theCouncil.In the communications which I have received from each,

there is a general recognition of the great value of thecourse which you propose to take. There is, indeed, somuch general approval of the Book of Forms, that I havefew suggestions, such as you invite, to make on the part ofmembers cf the Council.Your attention may, nevertheless, be drawn to the fol-

lowing particulars, which are noted in the correspondencewith the Council, and which appear to deserve considerationbefore a final decision is taken on so important a step as anew Form of Certificate of Death, although probably severalhave been already maturely considered by you :- (a) It isobjectionable that medical men should be required by law

, to give information which they do not possess from personalknowledge. (b) The words 11 as I am informed" should beprinted in the body of the certificate after the word "died."The marginal note should then stand thus :-Should themedical attendant feel justified in taking upon himself theresponsibility of certifying the fact of death, he may strike

, out the words 11 as I am informed." (c) The medical attend-

, ant ought not to have the duty imposed upon him of sendingto the registrar or to anyone else. The registrar should

apply to him. (d) In Scotland, the registrar forwards tothe medical attendant a certificate, with the blanks filledup as far as possible, with a stamped envelope addressed tohimself (the registrar), if the certificate has not been for-warded by the attendant within ten days. This plan worksadmirably. (e) In the Form of Death.Certificate, the words"whose apparent age was" should be substituted for" whose age was stated to be." (f) In case of alleged irre-gularities or frauds in respect of certificates, the Registrar-General or the magistrates, and not the Medical Council,should be prosecutors. (g) In the column "the duration ofdisease," there should be four divisiuns, for years, months,days, and hours, as in the Scotch certificate. (h) The Re-gistrar-general’s Abstracts should be gratuitously sent, asformerly was the case, to many registered medical practi-tioners-to all, indeed, who annually apply for them. Everyhealth officer, at the least, should have them officially.They should be kept at the office of every sanitary authority.Nor is there any reasonable doubt that statistical and sani-tary science, as well as the progress of accurate medical’knowledge, would be thus greatly promoted at a compara-tively trifling cost to the public funds. The services of’those who supply the basis of the Registration Returns.would also be gracefully acknowledged. A precedent maybe found in Scotland and Ireland and, formerly, in England.,

I have to observe that this was a question for which it.seemed to me undesirable to summon a special meeting of

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