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ticularly insisted upon by Mr. Erichsen, on the 2nd ofDecember, when a case of epithelioma affecting the entire

prepuce, and encircling the glans penis like a collar, was sub-mitted to the operation of removal. The disease had spread tothe glans, having commenced in the prepuce, and had assumedconsiderable dimensions, of a fungous character. The man’s

general health was good, and no glands of the groin were affected.He had had a congenital phymosis, which he had slit up himselfsome years ago. Amputation of the organ was performed byMr. Erichsen, with the removal of a good portion of the penileintegument, to prevent undue retraction of the stump withinit. The section of the diseased mass showed the disease to beeonfined almost solely to the prepuce, but the septum betweenthe corpora caverllosa and spongiosum was certainly thickerthan natural, but we can hardly suppose it to be the result ofthe disease.

MEDULLARY CANCER OF THE KNEE.

THE disease in this instance had been but of eight months’standing when the patient, an unhealthy-looking man aboutthirty-five, was admitted into St. George’s Hospital. He hadat the same time symptoms of chronic inflammation of the car-tilages ; and a little tumour was always present in front of theknee, above the patella, which looked as though it were aboutto suppurate. This enlarged, and was diagnosed to be malig-nant disease, the patella becoming laterally displaced. Underthese circumstances, as the disease was local, the leg was am-putated, by Mr. Csesar Hawkins, at the middle of the thigh,on the 10th December. A section was made of the disease,which was found to be as large as an orange, existing right infront of the condyles of the femur; it was distinctly medullary,as was suspected. There were several spiculæ of bone scat-tered throughout the tumour, which might lead to the suppo-sition of its being myeloid; but the appearance of yellow mat-ter in the centre was, Mr. Hawkins thought, quite decisive ofthe nature of the disease. The disease was completely isolated,holding out a prospect of cure, at anyrate for the present.

RECURRENCE OF CANCER, IN THE SUB-MAXILLARY GLAND.

Six years ago, an epithelial cancerous growth affected theright side of the lower lip, which was removed by a V-incision,and the wound healed up kindly. A year after this, the samedisease appeared in the left side of the lower lip, which wasremoved in a similar manner and with similar rssults. Thesubject of these operations is now an old man of seventy years,under Mr. Curling’s care at the London Hospital, with a deepexcavated ulcer, larger than a crown-piece, situated over theright sub-maxillary gland, with some surrounding irritationand induration. The treatment adopted in this case is, thelocal application of the chloride of zinc, with, so far, good re-sults ; for on the 17th December the ulcer had commenced tocicatrise at its right margin. The old man has been an inve-terate smoker. There is no hereditary predisposition to accountfor the appearance of the growth, six years back, in the lip.

STRUMOUS DISEASE OF TESTICLE; CASTRATION.

IT] appears that the patient, a pale, delicate-looking man ofabout thirty years, in University College Hospital, has haddisease of both testes for some years; the left had suppurated,been opened, and the old cicatrix remains. In the right thereis a large protruding fungous mass, of a pale-red colour, andcontaining in its substance almost the whole of the organ, asonly a portion of the epididymus was actually in the scrotum,which was otherwise nearly empty. The question which arosein the treatment of the case was, should the mass be entirelyremoved, or only a portion of it, detaching the scrotum aroundthe remains, and covering the section ? If the whole of it weretaken away, the patient would have no secreting structure tomake use of. Mr. Erichsen shaved off the projecting mass, buton doing this he found the whole organ infiltrated with tuber-culous masses, which moreover penetrated deeply; he conse-quently decided on removing the entire testicle, which wasaccordingly done. The tuberculous degeneration existed tosuch a degree that, if left, it would have been the nidus forfuture suppuration and trouble to the patient. A section ofthe diseased structure revealed complete destruction of thegland tissue. The man has made a good recovery.

LIFE ASSURANCE OFFICES AND THE PROFESSION.-The directors of the Metropolitan Life Assurance Society have ’,recently come to the decision to allow a fee for replies to theinquiries addressed to the medical referee.

Reviews and Notices of Books.Annual Report of the Royal Lunatic Asylum of Aberdeen.

1857.Thirtieth Annual Report of the Directors of James Murray’s

Royal Asylum for Lunatics, near Perth. 1857.Annual Report of the Committee of Visitors of the Surrey

Lunatic Asyl?,tm, for 1856.THERE is no more dispiriting and unsatisfactory task than

that of conning over the reports of lunatic asylums. Broadfacts there are of a most encouraging nature in connexion withthe potentiality of cure under certain ascertained conditions,and in connexion also with the progressive code of lunacytherapeutics, -but the details are painful in the extreme.

Psychological fragments, shadows, distorted images of the

divine likeness, are subjects of study calculated to engendersad thoughts. The sound of

" Sweet bells jangled, out of tune and harsh,"

is a doleful one, and all the science in the world can nevermake an attractive subject of one " blasted with ecstasy."The very cheeriness of some of these reports is inexpressiblysad and dreary, melancholy as the cachinnation of a gibberingidiot, dreary and sad as the meaningless smile of a darkenedsoul.

Every one of these productions, however, bears a harvest offacts, capable of being turned to practical account. If societywould only take to heart the lessons contained in reports oflunatic asylums, we should have fewer lunatics. The predis-posing and exciting causes of mental aberration are not merelylaid down with an appalling accuracy and certainty, but thevery means of avoidance are suggested at the same time. Baneand antidote are here almost on the same page. And not onlyare we supplied with instructions as to the avoidance of mentaldiseases, but wide statistics, and how the best chances of

speedy and permanent recovery may be secured. Let us turnto some of the particulars in these Reports.Intemperance is, as usual, shown to be the most prolific indi-

vidual cause of insanity. Even in those asylums where theproportion of cases from this cause is comparatively low,drunkenness is still the great creator of lunatics. Here aresome significant figures. Amongst the admissions, the per-centage of cases caused by inebriety was as follows:-In

Aberdeen Asylum ............... 15

James Murray’s, near Perth ......... 10

Surrey County .................. 6

Bethlem (..................... 5Kent ..................... 5

DevonScotland enjoys a bad pre-eminence in the matter of pota-

tions. Lunatic asylums and police returns prove it, if the lessaccurate testimony of general belief were wanting. Even in

Murray’s Asylum, where there are so many patients of the higherclasses that Dr. Lauder Lindsay says " this cirunstance gives apleasing tone to our society," the percentage of cases arising fromintemperance is nearly double that of the Surrey County Asy-lum, which is wholly devoted to paupers, and receives thesweepings of such neighbourhoods as Battersea, Bermondsey,Camberwell, Newington, Lambeth, and the parish of St. Georgethe Martyr. It is curious, too, that the relative proportion ofinebriates in Scotland and England is shown to be nearly thesame in both sets of statistics. For every person taken incustody in London for being drunk and disorderly, two aretaken into custody at Edinburgh and three at Glasgow. Theratio varies between one to two and one to three. These facts

ought not to be without their lesson. The roystering poet whowrotewrote

" Freedom and whisky gang thegither,"

might have sung a sa.dder and a truer strain; madness and

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whisky have a much closer connexion. Fever, grief, and re-verses of fortune appear, next to intemperance, to be the mostprolific sources of insanity. Hereditary predisposition wastraced in 38 per cent. of the admissions into the Aberdeen

Asylum.The vast majority of all cases of insanity recorded in the

above reports are mania and dementia. Nearly double as manycases of mania as of dementia, find their way into the SurreyCounty Asylum, but they are more curable. To speak in thegross, half of the mania cases recover, and only a fifth of thoseafflicted with dementia. This may be accounted for, however,partly, by the circumstance that cases of mania generally comeunder treatment sooner than cases of dementia, on account 01the violence of the former; and early treatment is the greatsecret of cure. This will not display the exact relations of thetwo forms of insanity, however, unless the termination of theuncured cases is taken into account. Notwithstanding thefact that mania is nearly twice as frequent as dementia, moredeaths took place amongst the dements than the maniacs inthe Surrey Asylum during the year 1856. Dementia, in fact,is less curable, and more fatal, than mania; general paralysisand other nervous diseases are more frequently combined withdementia than with the other forms of insanity.The greatest proportionate number of recoveries appears to

take place in mania and melancholia.The Report of Murray’s Asylum, which is almost entirely

the report of Dr. Lauder Lindsay, requires some particularnotice. It is a most exhaustive production as regards the re-pertory of subjects included in it, and might almost be expandedinto a treatise on lunatic asylums. In setting out it is an-nounced as a " gratifying fact," that the number of admis-sions, applications for admissions, and recoveries, are on the

increase. Probably the public will look upon the last of theseonly as " gratifying," for certainly, however pleasing it may beto cure lunatics, it would be much pleasanter to have none atall. The public is not likely to sympathise very keenly withthe increment of business done at the Perth Asylum, and wewould, therefore, advise Dr. Lindsay in future to confine hisgratulations to a more legitimate subject. Dr. Lindsay espe-cially insists upon two very important points-viz., earlytreatment and premature removal. It would be well if the

public knew how incalculably the chances of recovery are en-hanced by early attention, and how dangerous it is to removepartially-recovered lunatics from the scenes amongst whichthey are becoming repossessed of their mental equilibrium.It would be a charity to popularise the knowledge of the facts.The keep versus cure idea is also discussed, and much infe-rential discredit is thrown upon those who keep cheap board-ing-houses for lunatics. Where the rate of pay is small, andthe profit to be squeezed out of the patients, it is of course adesideratum to have as many boarders as possible, and to keepthem as long as possible, at the smallest possible expense. Itis a pity, as Dr. Lindsay remarks, that the interests of thesekeepers of private boarding-houses should be against the wel-fare of the patients. It is amusing to find such remarks fol-lowed by a disclaimer of any desire to cast an imputation uponthe persons alluded to; it is like working out a problem, anddeclining to accept the result; it is as if one should say, " twoand two are very easily added together, if you choose to per-form that arithmetical operation, and if you do add them to-

gether, the result will be four; but please to bear in mind, thatI don’t add them together, and am wholly irresponsible for anysuch addition sum, and that I distinctly decline to assert thattwo and two are four."

However, the law of libel is comprehensive. Scotch juriesare fond of giving heavy verdicts, and our northern brethrenare cautious : hence Dr. Lindsay’s discretion, which is perhapsthe better part of valour. The existence of special lunaticasylums is strongly urged. Criminal lunatics, incnrables, andidiots certainly ought to be segregated. urther than his we

should hardly be inclined to go in splitting up lunacy practice.The first class should be alone, for the obvious reason that their

presence is regarded by many patients as a degradation; in-

curables dead-lock institutions, which ought to be available forthe cure of lunacy; and idiots require and benefit by a specialsystem of education.

Dr. Lindsay has evidently taken much pains with his

specialite. He has analyzed the blood and the urine of hispatients. Of neither, however, can he speak in such a manneras to throw any light upon the general pathological state of theinsane. Neither does he believe that there is any special con.nexion between any particular form of disordered urine andinsanity; for although phosphates and other deposits werefrequent, they were not more so than in persons of soundmind. The question of inordinate mental exertion is entered

into, and Dr. Theophilus Thompson’s opinion on this headseems acceptable to Dr. Lindsay. The first step is mal-nutri.tion, a cacoplastic state of the blood, induced by deficientaeration of the blood, deficient diet, exercise, sleep-a reversal,in short, of all the conditions under which nutrition flourishes.Mal-nutrition of the brain may plunge the habitually over-tasked thinker himself into an abyss of madness, but the effectupon his offspring is more certain. Hence the common factthat great men’s sons are often little better than fools. This isa consideration which should make all men pause and consider

whether, in the race after distinction, they may not be humi.liating themselves in their posterity, or even bearing downupon foaming breakers on a lee shore, and wrecking themselves.The publication of crimes has, in Dr. Lindsay’s opinion, an un-favourable effect upon the public mind, having a tendency toproduce cases of impulsive insanity, such as homicidal mania.-Cases in support of this opinion are given, and a strong protestis entered against the out-speaking of the press. Such a course

may be productive of some imitations; but we very muchdoubt whether the social advantages of publicity are not ofsuch an overpowering nature as entirely to override the irn-portance of the imputed stimulus to crime. Such crimes can

only be the result of an exciting cause acting on a morbidlypredisposed brain; and even supposing the particular impulsegiven by reading the details of a murder to be wanting, it mustremain that there are numerous other quarters from whencesuch an impulse may come; and that a perusal of a true andparticular account of the assassination of A. is but one of manypossible points of departure from moral self-control. But wemust leave this Report.The Surrey County Lunatic Asylum Report is almost wholly

taken up by the Daniel Dolly case. Into this we do not againfeel at all inclined to go. All parties concerned will, doubtless,have improved the occasion, and learned a lesson which itmust surely now be unnecessary for us to give.

The Microscope: its History, Construction, and Applications.By JABEZ Hoaa. Third edition. Routledge and Co.IF the number of copies sold be any indication of the merits

of a work-and we consider that it is one of the best and mostsevere tests-that of Mr. Hogg is eminently meritorious. In.an exceedingly short space of time it has passed through threeeditions, each of 5000 copies. Fancy 15,000 copies ! Whatwould not some authors think of their success if they sold asmany hundreds. We know that the majority of works whichare issued from the press are not sold by as many tens ofhundreds. The volume has been reduced in size without anyabridgment,-indeed, with a considerable addition to its eon-tents. The experienced microscopist will find in it not onlymuch that is new to him, but hundreds of descriptions andengravings of objects that, some time or other, have occupiedhis attention; whilst the general reader will find in it muchinstructive information. Altogether, it is a deservedly popularwork, and one which should be found on the shelves of everywell-furnished library.