action he believes that it has a great influence in preventing hepatization of the lung structure, or, if this stage of the disease has set in, in preventing the spread of the consolidation. Until the pathology of pneumonia is better understood, it will not be easy to give an explanation of this supposed action of chloroform. There are good reasons for believing that the term acute lobar pneumonia may include more than one distinct disease, for recent observations tend to show that there is really a specific fever, having for its local lesion a croupal exudation into the air cells.

Balfour, however, denies the existence of a true specific pneumonia. When blood-letting was so frequent in the treatment of pneumonia, many cases were recorded where the disease was seemingly cut short. No doubt many of those so-called cures were instances of the natural resolution of an embolic pneumonia; for it is well known that the latter form of the disease runs a very short course. It seems superfluous to add that Dr. Balfour, who has a very extensive acquaintance with embolic pneumonia, would not include it in those cases treated by chloroform.

Dr. Balfour gives the chloroform internally, and in small doses, as it is given in Germany.

That chloroform possesses a wonderful influence in regulating and controlling the circulation, is well seen when it is given to patients almost moribund from heart disease or acute peritonitis. Dr. Balfour speaks highly also of its use in angina pectoris: it is preferable here to morphia, on account of the quickness of its action, and to nitrite of amyl because it is not followed by any unpleasant after effects. It is seldom that patients will take amyl a second time, on account of the unpleasant fullness of the head that it produces.

The following is a well marked case of acute miliary tuberculosis in an adult.

A female domestic servant, aged 21, was admitted into the infirmary, on the 7th January 1879, under Dr. Claud Muirhead's care. Five days before admission she was noticed to be fretful and altered in character. She complained of headache. The family history was not obtained. Her state on admission

was as follows:-The temperature was 101°, pulse 70, bowels constipated, answers to questions are incoherent. She lay in a state of coma vigil during the first night. On the following day the pulse was fallen to 60; the temperature in the morning was 100°, in the evening 100.5°. The pain in the head, which previously was confined to one side, had now extended all over the vertex, and was of a very severe character; the pupils sluggish. On the 9th, pulse 60, temperature 100°; passed only 20 oz. of urine during the last 24 hours. During the next few days the temperature varied from 98° to 100o, the pulse from 50 to 70. She has been either delirious or in a semicomatose state. On the 15th a double divergent squint was noticed; passed a very delirious night. On the morning of the 16th temperature 100°. pulse 82, urine 10 oz. Died on the evening of the 16th.

Post-Mortem.-Brain-The dura mater was not adherent to the bone. The vessels of the vertex very full. The convolu-, tions greatly flattened. The lateral ventricles only contained three pints of serum. Pons and medulla felt hard. The membranes in the neighborhood of the circle of Willis thickened and milky. The small vessels here and along both Sylvian fissures were covered with small miliary gelatinous tubercles. The liver, spleen and kidneys were also dotted both internally and externally with bodies. of the same size and consistence. The same was applied to the lungs, but, in addition, there was in the apex of the left lung a caseous mass, one-quarter of an inch in diameter, which was undergoing liquefaction in its centre. The origin of the infection here was either this mass in the lungs, or an enlarged and pigmented caseous bronchial gland which was also present. The morning previous to death, one-third of a grain of pilocarpine was injected subcutaneously; this produced great salivation and sweating. The cause of the small quantity of fluid found in the ventricles was, no doubt, owing to the profuse diaphoresis induced by the pilocarpine. In proof of this statement we have the flattened condition of the ventricles, which shows that at one time there was a considerable pressure exerted on them. In the case of a child, seen by Dr. Balfour

where there was deep coma in the last stage of tuberculous meningitis, the injection of pilocarpine was quickly followed by the disappearance of the coma, but it soon returned. The most remarkable feature in connection with this case of miliary tuberculosis is its extremely rapid course. She died within three weeks (probably 17 days) of the first appearance of any symptoms.

Reviews and Notices of Books.

J. S.

A Practical Treatise on the Medical and Surgical uses of Electricity, &c., &c. By GEO. M. BEARD, A.M., M.D., and A. D. ROCKWELL, A.M., M.D. - Second edition, revised and enlarged, with two hundred illustrations, 8vo. pp. 794. New York, WILLIAM WOOD & Co., 27 Great Jones Street, 1878.

The first edition of this work appeared in 1871, and was very generally approved by the profession, so much so, indeed, that it was translated into German by Dr. Väter of Prague, a gentleman who has devoted much of his time to the subject of general electrilization.

Faradization is a general constitutional tonic, and is of benefit in a number of affections, as a therapeutic agent of great value, it has assumed a position of importance that can hardly be estimated. It is essential to the successful use of electricity as a therapeutic agent, that the practitioner should be familiar with its physical relations. It is in this knowledge that we notice the difference which results in the practical application of electricity in disease, by the blundering charlatan and the scientific physician; and we must regard the publication of this the second edition of this work as a matter of congratulation to the reading professional public, as its pages will be found to contain, as the author's term it, a "thoroughly sifted experience" of their own, from the time they entered on this specialty to the present period, as also a full and exhaustive resumé of all that has appeared from the pen of other authorities.

The explanation cf the chemistry of the batteries is full in detail, and will be found in accordance with the most recent chemical knowledge of the subject. To Ohm's law is assigned a special chapter, and it is made clear in all its practical relations. Electro-physics is treated of, and the most recent facts are given in a clear and compact style.

The chapter on Electro-physiology has received large additions, which includes a report of a number of experiments made by the authors during the past three years. The relation of electro-physiology to electro-therapeutics is prominently dealt with. Since the publication of the first edition of this work the method of central galvanization has been reduced to a system, and is here fully described and illustrated, and its advantages over local galvanization fully discussed. The various methods of using electricity are also described, as local Faradization, local galvanisation, electrolysis, and the uses of electricity in surgery as well as the galvanic cautery, these are all described seriatim. There is a chapter on apparatus, and the most recent improvements are given. The superiority of the continuous over the broken, or separate coil Faradiac machines, is likewise discussed. In the application of electricity by the surgeon the method of applying the galvanic cautery, and ordinary electrolysis is described, and the results from a very large experience in this department are given, so that we may here learn what can be done, and what cannot be done by electricity in surgical disease. In the clinical descriptions, the successes and failures are fairly represented.

The work has been greatly enlarged, but in this enlargement new matter is given, material which embraces a larger practical experience of the uses of electricity in disease. The work is illustrated throughout with 198 engravings on wood, and to those who desire to employ this valuable therapeutic agent in the treatment of disease, we can alone observe that this work will be found indispensable.

On Loss of Weight, Blood-spitting, and Lung Disease.By HORACE DOBELL, M.D., &c., &c., Consulting Physician to the Royal Hospital for Diseases of the Chest, &c., &c. London: J. & A. CHURCHILL, 1878. 8vo. pp. 275.

Pulmonary Consumption being so frightfully common-place a disease in nearly all temperate climates, all matters connected with the elucidation of its causation and pathology are of the very highest practical importance to every zealous physician. How anxious every patient is about what is to follow when he has had an attack of hæmoptysis. The public know—it is notorious-that this often seems to be the precurser of permanent organic changes in the lungs. How eagerly, therefore, the subject of it seeks the counsel of his physician for the prevention of the threatened evil, or, better still, the consoling experience that he has it not to dread. The relationship of hæmoptysis to lung disease has long been a debated point in the pathogenesis of phthisis. Its exact position in this respect is yet by no means settled. Every attempt to assist in the solution of these problems is to be gratefully accepted by the profession. In this work Dr. Dobell has offered to us a large amount of material of much interest and instruction with reference to the relations between loss of body-weight and blood-spitting to coexistent or subsequent pulmonary disease. Much of the value of the book is derived from the large numbers of original observations-frequently accompanied by carefully-tabulated statements, brought together and compared specially with the view of throwing light upon the matters under discussion. All the more recent views of the principal writers on Consumption are also passed in review, and looked at pro and con, both from their own stand-point and also in the light of the author's own observations. We have much pleasure in bringing to the notice of our readers this further contribution of this well-known writer to the clinical study of Consumption. It will be found full of interest, and a good guide and assistant in forming opinions upon the important points set forth in its title.