general hygiene of the ear. This little work is written by a gentleman who is aurist to one of the hospitals in Philadelphia, and also consulting aurist to the Pennsylvania institute for the Deaf and Dumb. It is full of instruction, and will be found to fulfil the object desired in its publication.

A Clinical Treatise on Diseases of the Liver.-By Dr. FRED. THEOD. FRERICHS, Prof. Clinical Medicine in the University of Berlin, &c. In three volumes. Vol. 1, 8vo. pp. 224; Vol. 2, pp. 228; Vol. 3, pp. 226. Translated by Charles Murchison, M.D, F.R.C.P., &c. New Nork; WM. WOOD & Co., 27 Great Jones St., 1879.

These three volumes form a part of the Library of Standard Medical authors which are being published by Messrs. William Wood & Co., of New York. These volumes will be regarded with more than usual interest at the present time, as both the author and translator have been removed by death. Still, this work remains a monument of accurate observation and untiring industry, a reliable book of reference in diseases of the liver. Written nigh twenty years ago, the information contained is as fresh and applicable as though its publication carried with it all the freshness of a new work. There are numerous illustrations on wood, and on the frontispage of each volume will be found a coloured lithograph. Many of the figures here portrayed are copies of plates which were issued to accompany the English translation of the work which appeared some years back in the New Sydenham Society. We regret to observe that some of the wood engravings in the text of these volumes are very poor, indeed we think they mar the appearance of the work, giving to it an unfinished cast which is not in keeping with the general get up of these volumes. It is true that those volumes are issued at a nominal price, and therefore we are not to expect too much. This we admit, but we should be far more contented to see the illustrations left out altogether, than to have the entire volumes spoiled by second or third-class wood cuts. We should be sorry to damp the ardour of the publishers by uncalled for *observations on this subject. We make these observations believing as we do that kindly criticism is beneficial in every

way, and that it will in all likelihood call attention to what may have been an oversight in examining the work done before admitting it to publication: that is excluding or refusing to receive work of this nature which is not up to the level of a skilled workman. Frerichs on the liver is so well known and so generally appreciated by the profession that no observations as to merits are demanded at our hands. We need only in conclusion remind our readers that three monthly volumes are coming to hand with regularity. We have before alluded to the scheme as proposed and being in good faith carried out by the Messrs. Wood of New York.

An Atlas of Human Anatomy, illustrating most of the ordinary Dissections, and many not usually practised by the student.-By RICKMANN JOHN GOODLEE, M.S., F.R.S. Quarto. part 1st, four plates. Philadelphia: LINDSAY & BLAKISTON, 1878. Montreal, DAWSON BROS., St. James Street.

We have seen the first fasciculus of the American reprint by Lindsay & Blakiston, of Philadelphia, of Mr. Goodlee's plates, and we are well pleased with them. The possessor of a Maclise or a Lizars might imagine that he had all that was desired in the way of plates, but these plates are entirely different from any of their predecessors. Though artistically not so fine as Maclise's, anatomically they are quite as correct. Their peculiar utility lies in the fact that they represent dissections not usually made by either teacher or student. Inasmuch as the surgeon must be prepared to cut everywhere and anywhere, it behoves him to let his studies extend beyond the limits of dissecting-room routine.

Tablets of Anatomy and Physiology. - By THOMAS COOKE, F.R.C.S. Second edition. Longmans, Green & Co.Tablets of Physiology.-By same author.

These tablets in book form are now making their debut amongst the members of the profession in America. However, they are old friends of ours, and we know their usefulness. The student will find that Mr. Cooke's teaching is very exact, very clear, and best of all, very condensed. We should advise no

student to depend entirely on a book of this sort. The author does not wish him to do so, but he should use his tablets to refresh his memory before presenting himself for examination. The physiological tablets we like very much. The student of to-day has so much theory and conjecture to deal with that he will hail with delight the appearance of this book, which supplies him directly with the acknowledged facts of Physiology. We recommend students to provide themselves with the tablets on Embryology, for they will thus gain great assistance in mastering this difficult subject.

Habershon on the Alimentary Canal. Second American from the third enlarged and revised English edition. Philadelphia: HENRY C. LEA, 1879.

We can do very little to add to the favourable reception which has already been given by the Medical press of the world to this well known treatise. We however, remind our readers that this is a new edition of a work for which the demand was so great that previous editions were rapidly exhausted. The author has taken the opportunity of the book being out of print for some years, to embellish what he has already written, and to add new matter of very considerable importance.

We commend to all practitioners a careful perusal of Dr. Habershon's work. More especially, we draw attention to the number of cases of intestinal diseases recorded in its pages, cases of extreme interest clinically and pathologically. This careful record shows that this work is no complication, but a careful exposition of the author's personal experience.

An Introduction to Pathology and Morbid Anatomy.—By T. HENRY GREEN, M.D., Lond., &c. Third American from the fourth revised English edition. 8vo., pp. 331. Philadelphia: HENRY C. LEA, 1878.

This work has received an addition of much new matter which renders it more complete. All the chapters have been carefully revised, and the number of illustrations have increased. We have on a former occasion noticed at some length this excellent treatise which still retains its position of being a favorite textbook.

Extracts from British and Foreign Journals.

Unless otherwise stated the translations are made specially for this Journal. Intestinal Obstruction and Death.(Fatty change (and failure) of the muscular wall of the gut, as a direct, and indirect cause of intestinal obstruction and death. By FOURNEAUX JORDAN, F.R.S., Surgeon to the Queen's Hospital, professor of Surgery at Queens's College, Birmingham, Consulting Surgeon to the Women's and the West Bromwich Hospitals.)-For several years past, I have from time to time seen cases in which, with, perhaps no premonitory symptoms, continuous vomiting and tympany, lasting one, two, or more days, have been followed by death. While these symptoms appeared in some cases to come on spontaneously, in others and and I think, more frequently, they followed some abdominal or pelvic operation. The case, as a rule. happened in fat persons, in persons with large abdomens, in persons with signs of degeneration in various organs and with a history of habits which lead to visceral changes. Examination of the bodies disclosed great internal accumulations of fat, and occasional indications of visceral degeneration, but, curiously, no obvious or recognized cause of intestinal obstruction. In all the cases, the intestinal canal was greatly loaded with fat, and presented a strikingly yellow appearance; in some cases, indeed, it seemed to be simply a tube of fat. In one case the microscope conclusively showed that the unstriped muscular fibres of the bowel were converted into fat. In observing and reflecting on these cases, of some of which I shall speak later, I have arrived at the following conclusions:

1. The smooth muscular fibres of the bowel are subject to fatty degeneration, which may become more or less complete; and that, consequently, they may, and do in given cases, wholly cease to contract.

2. This fatty change of the essential element of the gut-wall when it ends in complete cessation of contractility, causes death by intestinal obstruction. Fatty failure of the intestines being in some cases extensive in area and reaching high up towards

the stomach, the ensuing obstruction is acute, the vomiting incessant, and death early. In other cases, there may be less complete, or more limited, or irregulary distributed fatty change; and there will follow a slower or more fitful stream of symptoms and a later death.

3. Fatty transformation in the gut is more likely to appear (though perhaps not exclusively) in fat, especially very fat persons; in those who from natural tendency, are liable to have fatty degeneration of other organs, especially of the heart. Death in heart cases is quick and direct; in intestinal-cases, slower and more indirect, but nevertheless very certain.

4. As premonitory syncope or exhaustion may happen from time to time before death from heart-fattiness, so "attacks" of obstruction may run before final obstruction from intestinal fattiness.

5. Failure of the bowel is helped on by continued flattulent distention, however it arises; the altered muscular fibres being so injured, by overstretching that they never regain their functional contractility. Herein may be traced a likeness to atony of the bladder, where, it is well known, long-continued distension is in certain cases followed by entire loss of contractility; and it is not unlikely that fatty conversion of the muscular wall of the bladder is the basis of certain obscure cases of retention and cystitis coming on after middle age. It is conceivable that healthy gut may become the subject of fatal atony from long-continued stretching; but some, however slight, fatty change would, greatly favor such a result.

In a limited number of cases, death is due directly to failure of intestinal action, and may come with obviously exciting cause. The muscular fibre is now no longer muscular. In a large number of cases, death comes more indirectly from some immediate shock to the abdominal organs. In strangulated hernia, when fatty bowel is present, the blown-out tube never again contracts. The vomiting continues, or returns, and death follows, notwithstanding that reduction has been easy and complete, and that there is no inflammation, or gangrene, or other cause of death. All injuries and operations in persons with failing gut are liable 31

NO. LXXXII.