practitioner of medicine. No alteration in the arrangement of subjects has been made in this edition, and there does not appear to be any very material change in the views enunciated in the first edition. Additional illustrations are given. The American editor has found that very little was demanded from him to render the work complete and accurate. The additions made by him are confined to points in which the experience and practice of American obstetricians differs from that of their English brethren. These are chiefly on the subject of the Cæsarian section. The variety of forceps and the method of application, dystochia from tetanoid uterine constriction, and the intravenous injection of milk as a substitute for transfusion of blood. We commend this work to our readers, it is a text-book containing the authoritative utterances of a practical man of large experience. It is to be had of Dawson Brothers, St. James Street.

Elementary Quantitative Analysis.-By ALEXANDER CLASSEN, Professor in the Royal Polytechnic School, Aix Le Chapelle, translated with additions by EDGAR T. SMITH, A.M., M.D. Philadelphia: HENRY C. LEA, 1878.

This is a particularly useful work on quantitative analysis, specially adapted to the beginner, by following out the scheme adopted in this book the student is led from simple quantitative determinations to more complex forms of analysis by degrees, and is, in fact, educated from the stepping stone to the complete quantitative analysis of inorganic structures, to which is added analysis of mineral waters. These are familiar to the different substances mentioned, and the composition of many of the minerals is given.

It is well illustrated with good practical illustrations, well drawn, and free from the mistakes so common in such works of putting glass flasks on a naked metal retort-stand. In the illustrations in this book the metals or flasks are represented properly protected.

There is at the beginning of the work a good table of contents, and at the end an excellent table for calculatiug analyses, giving

the atomic and muscular weights of elements and their compounds, aud the quantities percentically stated.

This is succeeded by a table of tension of aqueous vapour— and for the calculation of the hardness of water by soap test, and lastly by a copious index. The descriptions are clear, and concise, without sacrificing efficiency. The print is clear and easily read, the paper is good and strong; altogether, we can highly recommend this work to any one who is studying chemistry practically, especially those whose occupation will require a knowledge of quantitative analysis.

Extracts from British and Foreign Journals.

Unless otherwise stated the translations are made specially for this Journal.

Treatment of Ulcers & Varicose Veins. -In the Lancet for October 12th, a note on the treatment of ulcers and varicose veins by Martin's strong elastic bandage, appears from the pen of George W. Callender, F.R.S., Surgeon to St. Bartholomew's Hospital.-Having for some time used the elastic bandage as recommended by Dr. Martin, of Boston, U. S., for the treatment of varieose veins and ulcers, it is right to express my opinion that his treatment is practically good. Under its influence, ulcers not of a specific character do certainly heal, and quickly; and as thus effected whilst the patient follows his usual occupation, the merit of the treatment is evident. Although there has been scarcely time since I received the bandages from America for use in St. Bartholomew's Hospital, to test their efficacy in the continued treatment of varicose veins, yet I have found that the application of the bandage is at once followed by a sense of great relief. A man of thirty-six years of age, who had suffered for eleven years from varix of either internal saphenous vein, extending as high as the groin, experienced at once and since greater relief from the use of the bandage than he had ever had from silk elastic stockings, although his position was such as to allow his wearing the best which could be made for him. I have used the bandages for many cases of ulcer of the leg, chiefly due to varicose veins. and always with the good

result stated by Dr. Martin, with whose practical statement respecting the treatment of these ulcers I agree.

There are some points named by Dr. Martin which are essential if good results are to be had. The first of these is as to the quality of the bandage itself. It should be just as the author describes, and is supplied from America. If thicker, it should be clumsy; aud if thinner, it needs to be more tightly drawn to offer the due resistence, and the edges are more apt to indent or cut into the flesh. If Dr. Martin's treatmeat is to be tried, the bandage is such as his experience has led him to prefer.

The bandage should be applied before the patient rises from his bed in the morning-before, that is, the veins of the leg become distended by the impeded column of blood within them. It should be applied with just snugness enough not to slip down." The moment the foot is put to the ground the limb is so increased in bulk by the increase of blood in the veins that the bandage becomes of precisely the proper degree of tightness, and no matter how active the exercise or labour of the patient, it will remain in position all day. When the patient undresses at night the bandage is to be removed, and the limb wiped dry, a piece of soft old linen moistened with oil, or some equally simple dressing, laid on the ulcer and retained in place by a few turns of an ordinary roller. The bandage should be sponged with water (cold will do, but warm is better), and hung over a line to dry in readiness for the morning, or it can be wiped dry at once, or rolled up with the tapes in the centre. Such is the

dressing for the night; in the morning the leg can be washed, but, whether it is or not, all traces of oil or cerate should be carefully wiped away, as contact with the bandage of any fatty matter would tend gradually to injure the rubber. This is the whole treatment. Rubber bandage all day, with erect position and exercise. The simplest possible dressing (merely to protect the ulcer from injury), with the horizontal position and rest, all night. Any pimples which may form are left to be treated by the rubber, and if the skin becomes chafed, a light covering, as of bunting, is applied as a bandage under the rubber, and the same is recommended to absorb excessive moisture.

No more distressing cases than of patients suffering from chronic ulcers crowd our hospitals, and I must say that I feel much indebted to Dr. Martin for the suggestions he has published, and which he has made practical application of for many years with, as he says, great success. My present but recent experience, leads me to believe that he is to be confirmed in the statement he makes, which any who like can read, as it is very clearly and ably put in the Transactions of the American Medical Association for 1877.

Extrophy of the Heart.-(By JOHN T. HODGEN, M.D.) Mrs., a German, at term, attended by Dr. BERNAYS, in February, 1864, gave birth to a healthy living child. The heart was found entirely outside of the chest, the vessels passing from the chest through an opening in the median line. The heart was not covered by pericardium, and stood with its apex pointing forward, downward and to the left. The organ pulsated rapidly but regularly with each elongation of the organ, the apex was pushed forward and swept to the left. The contractile wave, beginning at the auricles, swept over the ventricles.

On the third day after birth, the heart had lost its red color, being covered by a thick layer of fibrinous matter. This assumed a yellowish tinge, becoming softened, and was detatched, leaving the muscular tissue of the heart exposed and dry, or less moist than it had been.

On the fourth day, the auriculo-ventricular fissure became deeper, and presented a ragged-looking groove, which was deepened by the thickening of the borders.

On the fifth day the child died, and twelve hours after a post mortem examination was made in the presence of Drs. Hammer and Rogers.

The body was about the average size, and perfect except as noted. The distance between the inner ends of clavicles-i, e. the sterno-clavicular articulations-was 1 inches. The first and second pieces of the sternum were divided, leaving a space like the letter U; this cleft extended to a point opposite the

articulation of the fourth rib with the sternum, the opening being one inch in diameter.

As it approached the opening, the skin was continuous with a dense fibrous structure which was found attached to the great vessels (i. e., the pulmonary artery, the aorta, and the vena cava)-at a point corresponding to that at which the pericardium is attached. This connection served to hold the vessels in position as they escaped through the opening in the more dense structures. The heart was of normal size, but more elongated the apex being formed by the right ventricle.

On opening the chest no space was found for the heart, the mediastinum being central, with the phrenic nerves passing down in it near each other; the lungs filled the entire cavity, and each lung had three lobes. The hepatic veins ascended as a long single vessel to the right of the median line, in the mediastinum, to the opening in the sternum, and entered the right auricle of the heart on its right side and behind the opening for the ascending cava.

The ascending cava passed up the left side of the median line in the mediastinum, received the descending cava, and entered the right auricle by a sinuous passage, at the first passing downwards, then turning at a right angle to the right entered the auricle. The descending cava, half an inch long, situated to left of median line, received the innominate of right side, which was long and crossed the median line toward the left. The left innominate vein passed directly downward, and joined the right, on the left of the median line, formed the descending cava. A single pulmonary vein, formed by the union of a vein from each side, entered the left auricle. The pulmonary artery, having but two semilunar valves at its beginning, took its origin from the right ventricle; while immediately to its right, and from the right ventricle also, came the aorta. A free opening existed between the right and left ventricles. No foramen ovale existed between the right and left auricles, the septum being perfect; no dustus arteriosus.

Extensive and recent adhesions, formed by recently deposited lymph, showed the existence of peritonitis.-The American Practitioner.