Warning and frequent visits can alone avert a mistake at this period, for it is now that the real skill in medication is demanded, and upon a correct appreciation of the symptoms the life of the patient depends. If with the subsidence of the sthenic type of the disease, there appears a typhoid tendency, with prostration, we should not hesitate to sustain the patient; although the pulse be rapid, its volume will be found far below its standard, and unless prompt and efficient aid is afforded nature will sink and the patient die. Tonics are sometimes inefficient to answer the end, and I have had to resort to stimulants. Madeira wine I have found the best. Of the tonics, muriated tinct. of iron and bark, or its alkaloid, the sulphate, are the best; strychnia and iron also form an efficient and powerful tonic. If we follow the general rules of practice in the case of a typhoid patient, our success will be insured.

In the asthenic form of diphtheria the general rules of treatment will be based upon the stage in which the patient is found. If called during the premonitory stage, which is almost always of considerable duration, arouse the secretory powers of the principal organs by the use of the usual means; and if possible, to secure healthy secretions before the accession of the stage of excitement, use quinine and iron as a prophylactic, and introduce chlorate of potassa into the system freely to disinfect the blood, for I regard diphtheria as essentially a blood-poisoning as our most malignant typhus. In the stage of excitement, moderate the force of the circulation, but be careful not to destroy the tone of the stomach. Keep it intact, if possible, for with the first signs of nausea the disease resumes a more dangerous character. The septic tendency will indicate the free employment of disinfectants, as chloride of lime, in the apartment where the patient lies. The clothes must be frequently changed; the bath, warm or tepid, according to the condition of the heat of the body, should be employed occasionally to restore the function of that important organ, the skin, and also for the sake of healthful cleanliness; pure air is all-important. When the pyrexia ceases, and the work of prostration begins, meet the indications with stimulants or tonics as the case may require.

Of course the local difficulties of the throat will need early and assiduous attention. Insufflations of powdered burnt alum, every one, two, or three hours according to the urgency of the case, and the steady and frequent removal of all appearances of plastic exudation, whenever it forms, so as to give the alum a fair opportunity of reaching the seat of disease, I have found usually sufficient. Touching the spots with nitrate of silver was a favorite plan with me, but I have abandoned it for the use of alum. I am convinced of the great and paramount importance of the frequent use of these insufflations, in cases where the membranous deposit forms rapidly, from experience. If the larynx becomes involved the danger is increased an hundredfold, and it must be prevented by this treatment; even this, however, will fail sometimes, and then the method of producing a separation and expulsion, by the use of emetics, as practised in croup, comes foremost to the mind; but I never practise it; fear of disturbing the stomach prevents me. Instead of emetics I use a feather, or other convenient instrument, wherewith to procure such titillation of the fauces as will cause coughing, and the same expulsive efforts as ensue from emesis, without its debilitating effects. But this too will fail, and asphyxia seems imminent. What then should be done? Would any sane practitioner hesitate to announce to the relatives and friends of the patient, the importance of the sole remedy left? I grant that this is a fearful ordeal for the physician as well as the patient, but I would not deny them the only resource which remains when this moment arrives. Tracheotomy is the dernier ressort, and let it be done, hopefully and with confidence; but do not delay until the membranous deposit lines the bronchi. The exact moment of election must be left to the discretion of the attending physician, but I would advise that it be done early. Twice in my practice I have performed it, once only success

fully; but I think that the first case was operated on too late.

Convalescence from diphtheria is fraught with danger, and requires the enforcement of all the attendant's orders; it is tardy, occupying not weeks but months, and throughout the sustaining treatment must be followed.

Finally, let me say, I believe this affection to be contagious. I think that I am safe in asserting that I know it to be so. Let then the family physician, when called to such cases, warn the parents of the fact, and he will, in fulfilling this duty, perchance save the lives of some of the family.

Reports of Hospitals.

ST. LUKE'S HOSPITAL.

SERVICE OF DR. CLARK.

ANEURISM OF THORACIC AORTA.

[Reported by EDWARD B. DALTON, M.D., Resident Physician.]

A MAN, forty-three years of age, entered St. Luke's Hospital in April, 1860, having a small pulsating tumor situated just beneath the angle of the left scapula. He gave the following history:-"Having previously enjoyed general good health, he began, during the month of May, 1857, to be subject to severe pain in the left side, accompanied with palpitation of the heart, especially on violent exercise. These symptoms troubled him more or less constantly for the ensuing two years, though never compelling him to abandon his ordinary occupation, that of a weaver. In the month of March, 1859, he suffered from an attack of acute articular rheumatism, and some six weeks later entered St. Luke's Hospital in an enfeebled condition, and complaining of severe pain in the left side of chest, especially about the cardiac region, and of palpitation. The left

The

side of chest was moderately dull on percussion, its motion in respiration less free than that of the right, and its intercostal spaces more prominent. The respiratory sounds were feeble over the entire posterior aspect of chest. The apex of the heart was found at a point two and a half (2) inches below the nipple in a direct line. cardiac impulse was abnormally forcible, and perceptible over an unusually large area. On auscultation a souffle was heard over the left chest posteriorly, while over the situation of the base of the heart a double murmur was to be heard.

After several weeks the patient left the hospital much improved in general condition, and greatly relieved of his special symptoms, though by no means free from them. The thoracic pain and occasional palpitation continued to trouble him; and in February, 1860, his general health again failed to such a degree as to oblige him to give up work. A few weeks later, in March, he discovered the phenomenon for which, with its accompanying symptoms, he re-entered the hospital during the following month. At that time a pulsating tumor was apparent just below the lower angle of the left scapula, semi-ovoid in shape and measuring 44 inches in its longitudinal, and 34 in its transverse direction. The pulsation was forcible and expansive in character. The overlying tissues were tense and elastic; the skin retained its natural color, and there was no marked tenderness; there was no thrill. On auscultation directly over the tumor a distinct double murmur was heard; as there was also in front over the heart. A more extended examination detected moderate dulness on percussion over the left side of chest, with enfeebled respiratory sound. The ribs in the vicinity of the tumor were very slightly, if at all, abnormally movable. Upon this point there was difference of opinion. There was slight loss of sensation in the skin covering the chest and abdomen on the left side, but no muscular paralysis.

The patient suffered from night-sweats of moderate severity, but was able to walk about with ease. During the first six weeks of his residence here he suffered occasionally with moderate pain in the left chest, and with attacks of palpitation and irregularity of the heart's action. His general health became decidedly improved; the nightsweats abated, and the attacks of pain almost entirely ceased. The tumor steadily increased in size, retaining otherwise the same characteristics as at first. Through the month of June, the patient's condition was very good, and almost no medication was called for, except now and then for a recurrence of the night sweats. With the exception of a slight inclination towards the left side he walked erect, used his limbs with ease, and was able to be out of doors nearly every day. The tumor steadily increased in size, its right limit being close to the vertebral column, and its increase being towards the left and downwards. The same condition, with accidental variations, continued through July and the early part of August. At that time the tumor had reached the size of 64 inches lengthwise, and 4 transversely; and still presented the same phenomena as at first. During the latter part of August and September, the patient's general condition deteriorated very much, and he was frequently confined to his bed for several days at a time mainly from debility, at times amounting to exhaustion. He suffered but little pain, and no treatment was necessary, further than for nourishment and support.

Early in October, the increase of the tumor became suddenly more rapid. It was no longer confined to the left of the spinal column, but encroached upon the latter until it entirely covered it; and on the 22d of the month presented a transverse measurement of 7 inches, and a longitudinal one of 8. At the same time, a narrow and flattened extension of the tumor was observed from its lower edge along the left side of the vertebral column for some four inches, and having the same expansive pulsation as the tumor itself, although in a less degree. The paralysis of sensation over the surface of the left side of the chest and abdomen became more decided, but was still unaccompanied by any loss of muscular power. Pain in the chest became a troublesome symptom, and the patient's general condition rapidly deteriorated. The physical signs were in all important respects the same as at first. The tissues overlying and in the vicinity of the tumor were very tense, and the question of the mobility of the ribs was still mooted. Some of the gentlemen who examined the case felt satisfied of the existence of unnatural mobility, while others doubted or denied the evidence.

The constitutional symptoms now became steadily aggravated, and the pain more constant and severe, extending through both sides of the chest, and at times into the abdomen. The patient hardly left his bed, though he could sit up with ease, and apparently suffered from no impairment of muscular power further than that resulting from general debility. On the 13th November the tumor extended fully between the angles of the two scapula a length of eight inches, and measured nine inches in the opposite direction. On the 22d of November these measurements had increased respectively to eleven and thirteen inches. Still the physical signs and general phenomena remained materially the same as in the earlier history of the case; with the exception that as the protrusion and extension of the tumor became constantly greater, the double-murmur heard upon auscultation became less distinct, at times scarcely audible. The pulse at the wrist had now become very feeble, and was frequently so very small, and the patient's whole appearance indicative of such utter prostration, that it would seem impossible he should survive more than a few hours. The thoracic and abdominal pain was almost constant and very severe.

On the 18th of December, in view of the difference of opinion which had existed regarding the character of the tumor from the first, an exploratory puncture was made at a point near its upper limit, and three inches to the right

of the spinal column. The tumor was slightly softer in that situation than elsewhere, and a slender, grooved exploring needle was introduced throughout its entire length of 24 inches. The point of the instrument encountered resistance everywhere, and no cavity was reached. A few drops of fluid blood followed the withdrawal of the needle, and its groove was filled with blood and fibrine. A coating of collodion and lint was placed over the wound, and no unfavorable symptoms resulted from the puncture. At this time the tumor occupied the whole breadth of the back, standing out flush with either side, its transverse measurement being now the greatest, viz. seventeen inches, from above downwards it extended fifteen inches, and had a depth of seven inches.

With the exception of slight ulceration of the skin over the tumor, there was no marked change in the character of the patient's symptoms after the last date until the 9th of January, 1861, when he quietly died as if from exhaustion.

Autopsy, eighteen hours after death.-The appearance of the tumor was the same as before death, except that its tension and that of the adjacent parts was no longer present.

On laying open the chest old and firm pleuritic adhesions were met with, especially on the left side. After the removal of the lungs a tumor was disclosed lying directly beneath the aorta, just below the arch. Its long diameter, parallel with the course of the artery, was five inches, its transverse four and a half inches. The tumor was well defined, except on the left side, where its limit was lost in an irregular, flattened swelling which spread off to the ribs, and occupied an area of some four or five square inches. A longitudinal incision was made through the anterior wall of the aorta, through which was seen, in the opposite wall, a regular, oval aperture, about five-eighths of an inch in diameter, situated some three inches below the arch. This aperture communicated directly with the underlying tumor, which was now proved to be a pouch formed by an expansion of the arterial coats. Compression applied to the large tumor outside the posterior thoracic wall forced a stream of blood through this aperture. The body was now turned over, and an incision carried through the entire length of the external tumor, when the latter was found to be a pouch formed solely by the expansion of the tissues overlying the bony thoracic wall, and lined for a depth of three inches or more with dense coagulated blood. Within this was a cavity of considerable capacity containing fluid blood, and communicating with the internal or true aneurismal sac by an irregular chasm through the eroded bony wall, where the arterial coats had ruptured.

The dorsal vertebræ from the sixth to the tenth inclusive were considerably eroded, the seventh, eighth, and ninth extensively so, especially on the left side. At this situation there was slight lateral curvature, its convexity towards the right side. The fifth, seventh, eighth, ninth, tenth, and eleventh ribs on the left side were also partially destroyed, the ninth and tenth being severed from their connexion with the column, and wholly wanting for some three inches of their length. The spinal canal was nowhere opened into. Within the chest, beside the aneurismal sac, and to the left of it, the soft tissues had been forced off the ribs; thus giving rise to the flattened swelling observed in the early part of the examination.

BUFFALO HOSPITAL OF SISTERS OF CHARITY.

SERVICE OF PROF. T. F. ROCHESTER.

[Reported by H. P. BABCOCK, Student of Medicine.] ACUTE ARTICULAR RHEUMATISM SUCCEEDED BY PERITONITIS AND PERICARDITIS; RECOVERY.

JOHN MCHUGn, aged 19, was admitted December 8, 1860, suffering with articular rheumatism in the lower extremities, after an illness of five days; joints swollen and painful; pulse 85; high fever; tongue heavily furred; bowels constipated; heart sounds normal. He has had feb. int., and

states that he now has an exacerbation of fever every afternoon. B. Hydrarg, chlor. mitis et rhei aa grs. x. followed by rochelle salt 383., also quiniæ sulph. grs. vj. every four hours, and pulv. doveri grs. viij. at night. Cotton wadding around limbs. This treatment was continued till the 8th, when he complained of considerable pain in the abdomen, which was considered rheumatism of the muscular coat of the bowels. The treatment was continued, and a purgative enema administered. On visiting him next day, it was found that the abdominal pain had increased; that there was great tympanitis and tenderness on pressure, especially in right iliac region. Respiration was hurried and thoracic; decubitus dorsal, and knees drawn up; febrile movement intense; pulse one hundred and thirty; administration of quinia suspended; ordered pulv. doveri grs. x. et morph. sulph. gr. M. every four hours. Hot fomentations to abdomen. December 10.-No improvement. B. Hydrarg. chlor. mitis gr. j. et pulv. opii grs. ij. M. every four hours, and morphia as before. He gradually improved under this treatment till the 15th, when his pulse, which had fallen to one hundred, suddenly rose to one hundred and twenty, and was small and feeble. On auscultation over the cardiac region a well marked basic bellows murmur was perceived. The area of præcordial dulness augmented with local tenderness. Heart sounds faint and distant. B. Blister 3×3, to be dressed with ungt. hydrarg. mitis and pulv. opii every four hours internally. Calomel suspended, as it was producing free catharsis. Tr. opii 3j. by enema; beef essence freely. December 18. -Abdominal tympanitis and tenderness much less; area of præcordial dulness diminished; apex beat perceptible in fifth intercostal space; basic bellows murmur very faint; heart sound more distinct; pulse one hundred. B. Pulv. opii et quinæ sulph. aa gr. j ipecac gr. M. every four hours; whiskey every four hours. December 21.-Great improvement; pulse ninety; bowels more spontaneous. B. Quiniæ sulph. gr. i., pulv. opii gr. every four hours. From this time patient rapidly convalesced. The exceptional noteworthy feature in the above case is the supervention of peritonitis on rheumatism of the muscular coat of the bowels. subsidence of pericarditis under the almost exclusive use of opium and stimulants is likewise deserving of remark. No decided evidences of mercurialization could be detected on the gums or in the breath, and no mercury was given after the detection of pericarditis, except a little endermically in the form of ung. hydrarg. mite which was used for three days as a dressing to the blistered præcordial surface.

ss.

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and exposing the head of the os brachii, which was found to be dislocated on the dorsum of the scapula. The capsule was divided, and the extremity of the bone turned out. leaden spatula was passed beneath the bone to protect the soft parts, and a portion of the bone about three-quarters of an inch in length was removed with a saw. On examining the limb, and moving it in different directions, it was thought best to remove an additional portion of the bone. This was accordingly done, the second portion being nearly as long as the first. The hand was then brought forward across the anterior part of the chest, where it lay in an easy position, without apparent deformity. The edges of the wound were brought together by means of eight twisted sutures made with insect pins.

CASE 28. Reduction of Dislocation of Shoulder, Seven Weeks' Standing.-M. C., æt. 53. This man had a fall on his right shoulder nearly seven weeks ago, since which time he has not been able to use his limb. I find on examination that the acromion process appears sharp and prominent, and there is a hollow beneath it. The arm appears a little longer than its fellow, and the head of the os brachii can be felt in the axilla. These signs clearly indicate a dislocation downwards into the axilla. If this luxation had recently occurred, its reduction would be comparatively easy. In old dislocations, much greater difficulties are encountered. These difficulties arise from the contraction of muscles, and from the partial healing of the lacerated capsule. I will now bring the patient under the anesthetic influence of æther, and will make the attempt to reduce the dislocation, but as I am not provided with instruments, I may perhaps fail in the effort. (The patient was then brought under the influence of æther, and Prof. P., assisted by Drs. Hinton, Buck, and Krackowizer, undertook the reduction. The limb was brought over the patient's head, and extension was made in a direction towards the glenoid cavity, which counter-extension was made in the opposite direction. After continuing these efforts for a number of minutes, the arm was brought down by the side of the patient, a fulcrum was placed in the axilla, and the arm brought across the thorax. After repeating the extension and counter-extension several times, and as often having recourse to the prying motion across the chest, suddenly with an unusually loud snap the head of the bone went back into its place. The report was so loud as to lead to a suspicion that the bone had been fractured, but on careful examination it was ascertained that a reduction had been effected.)

UNIVERSITY MEDICAL COLLEGE.

PROF. ALFRED C POST'S SURGICAL CLINIC.

CURIOUS DEFORMITY; EXSECTION OF THE HEAD OF THE BONE. REDUCTION OF DISLOCATION OF HEAD OF OS BRACHII OF SEVEN WEEKS' STANDING.

CASE 27. Resection of Head of Os Brachii for Dislocation with Fibrous Anchylosis.-Rachel L., æt. 8 years. This is a pale and delicate looking child, who has a remarkable deformity of the right upper extremity. The father says that the arm was injured during the birth of the child, and that it has been deformed ever since. There is no considerable motion of the shoulder-joint, but the scapula moves freely upon the trunk. The position of the arm is that of extreme inward rotation at the shoulder-joint with the hand behind the back. The nutrition of the limb is defective, and the innervation is much impaired, so that the patient can exert but little power in its movements. I propose to make an effort to remove the deformity, and to restore the motions of the limb by exsection of the upper extremity of the os brachii, hoping that I may thus succeed in forming a useful artificial joint. (The patient was then brought under the influence of æther, and the operation was performed. A longitudinal incision was made near the posterior edge of the deltoid, dividing the fibres of that muscle,

COLLEGE OF PHYSICIANS AND SURGEONS.
DR. PARKER AND MARKOE'S CLINIC.
December, 1860.

CASE.-Cystitis.-Peter G., æt. 50, blacksmith, complains of dull pain in the loins, chiefly upon the left side, stretching across into the lumbar regions, and down into the pelvis. His trouble commenced about eighteen months ago, without any assignable cause. It has been gradually increasing in severity up to the present time. He is now unable to retain his water for more than a few minutes at a time, suffering great pain in the lower portion of the abdomen whenever he attempts to micturate. That portion of urine which first passes from his bladder is generally accompanied by mucus or pus, sometimes ropy, though never bloody. There is always a deposit of white sediment upon standing. His pulse is one hundred; tongue clean; eats well; sleeps well; and, aside from these symptoms, he has never had gonorrhoea nor stricture, and upon passing the sound into his bladder, no stone can be felt.

Remarks.-The symptoms which this man presents, viz. the dull pain in the back and pelvis coming on gradually for a year and a half, the irritability of the bladder, the frequent micturition, and unnatural urine, with the sediment of phosphates always present, are those of cystitis, and from the absence of any appreciable cause to which to

American Medical Times.

SATURDAY, FEBRUARY 9, 1861.

WET-NURSES.

WE some time since received a communication from an English correspondent who has given much attention to the subject of wet-nursing in its bearings upon the public health.

From this source we learn that at the International Statistical Congress, held at London last year, Dr. EDWARD JARVIS, a delegate from Massachusetts, in the discussion which followed the reading of a paper on the Statistics of Wet-Nursing, remarked that in the United States "the employment of a wet-nurse is very rarely resorted to; indeed, the custom is almost unknown there." This statement seems to have excited great interest, and has been the subject of much comment. Coming from a responsible source it has been received as authoritative, and has afforded good ground for the supposition that wet-nursing is by no means as necessary as the ladies of England seem to consider.

We do not know the source of Dr. JARVIS's information, nor on what investigations his conclusions were based. They should certainly have been arrived at only after extended inquiry, especially in our large cities, as, uttered in that high presence, they could not but have an important influence upon the discussions which followed the reading of the paper mentioned. Nor has their influence ceased with the adjournment of the Statistical Congress, but we now learn that subsequent writers have alluded to them as conclusive on the subject of wet-nursing.

Although we are not prepared to give statistical data, yet the results of extensive observation authorize us to state that wet-nursing is far from being unknown in New York city. On the contrary, it may be considered a very prevalent custom, supported alike by necessity and fashion. Whoever will consult the columns of "Wants" in our daily papers will soon become satisfied of the existence of this practice in our community, though it is not possible to obtain a knowledge of its extent from that source. To gain more accurate information of the amount of wetnursing requires familiarity with the lying-in departments of our public charities, and with the poor and unfortunate in

their homes. Extended inquiry of those who have devoted much time in public institutions, and in dispensary practice, confirms our own observations, that wet-nurses always find a demand for their services. The applications for wetnurses at our Lying-in Institutions often, indeed, greatly exceed the supply. There can be no doubt, therefore, that wet-nursing is more customary than Dr. Jarvis would believe.

The practice of wet-nursing grows out of:-1st. The inability of the mother to discharge her maternal duties; and, 2d. Either false pride, or an indisposition to be burdened with the care of her offspring. Both of these conditions exist in this, as in all large cities, and we are not a little surprised that an educated physician should have failed to recognise them. The first unquestionably renders the practice, to a limited extent, a necessity; the second springs from that social refinement which sets at naught all natural laws, and renders life, as far as possible, entirely artificial. The former of these causes, we are inclined to believe, leads to the employment of the wetnurse in the majority of instances in this community, though the latter exerts an influence to no inconsiderable

extent.

We have before us a paper on "The Practice of Hiring

Wet-Nurses considered as it affects Public Health and Public Morals," which was presented to the " National Association for the Promotion of Social Science," England, in 1859, by M. L. BAINES. The evils of wet-nursing are here presented in a two-fold light: 1st. Moral and Social, and 2d. Physical. The former grow out of the employment of fallen women, a practice urged by a class of philanthropists, but which cannot be too severely condemned, not only on account of its immoral tendencies, but also of the physical evils that are liable to be entailed upon the nurseling by the imbibition of constitutional proclivities to disease. The latter evils result both to the child of the nurse, which is either put out to an inferior nurse, or is hand-fed; and to the child which she assumes to nurse, owing to its deprivation of maternal milk. It is stated by this writer that, "It may be fairly assumed that the children of wet-nurses form a very large proportion of those who die prematurely." We are not prepared to indorse this, as a general statement, but we have the most undoubted proof of the great mortality among foundlings in this city; while they were put out to nurse, nearly one-half died annually. It appears also that out of every one hundred children in Paris, nursed by their mothers, eighteen die the first year, while of those wet-nursed, twenty-nine die.

The practice of employing wet-nurses, therefore, can but be considered an evil, and one which is destined doubtless to increase in the ratio of our increase in wealth and luxury. What is the remedy? The entire responsibility of resisting its progress rests with the medical profession. We should endeavor to remove the causes of the evil, by inducing mothers to rear their own children by the means that nature has given them. The arguments which may be employed are too strong to be resisted, if kindly, conscientiously, and firmly presented by the medical attendant. If this duty were thoroughly discharged, in every instance, the system of wet-nursing would at once fall into disrepute, and the custom would truly become what Dr. Jarvis represented it, "almost unknown" in this country. In the comparatively few cases where the mother is absolutely disqualified, it is still a question if artificial lactation, in the

hands of a competent nurse, might not be preferable to wet-nursing. But admitting that the wet-nurse must be obtained, the physician is still the adviser, and has it in his power to make the selection. And here occurs an important duty, which is almost invariably overlooked; if the wet-nurse has a child of her own, it is liable to be put aside without a care, or even thought, on the part of the employer. The physician should remember that, in providing a nurse for his patient, he is not less responsible for the life of the helpless human being which is set aside, and should insist that it be properly provided for.

We have done little more than open this subject, but if we have succeeded in impressing upon even a single physician the importance of discharging a duty long neglected, our purpose has been accomplished.

The New York County Medical Society held a monthly meeting January 19th, Dr. Bulkley, President. There was a large attendance. On taking the chair, the President delivered an introductory address, defining the past and present position of the Society. A paper was then read on the Pathology of Tetanus, by Dr. W. M. THOMSON, which has now appeared in our columns. It is proposed hereafter to hold monthly meetings for the discussion of scientific subjects. It will gratify the friends of county medical societies, to learn that the New York County Society, so long idle as to have become almost obsolete, has shown such evidences of vitality. Let it emulate the example of the Kings County Medical Society, now one of the most useful and influential societies in the State.

THE WEEK.

WE have received the announcement of the managers of BRIGHAM HALL, A HOSPITAL FOR THE INSANE, located at Canandaigua, N. Y. This institution "is designed for the accommodation of patients of the independent class, a class for which no adequate provision has existed in the State." It is under the medical supervision of Drs. GEORGE COOK and JOHN B. CHAPIN, men of ample experience in the treatment of the insane. Since its organization it has received 166 patients, of whom 49 recovered, 40 improved, 19 unimproved, 10 died, 48 remain. We are glad to learn that this enterprise gives fair promise of success. It commends itself to the medical profession of the State as an institution to which they can direct those insane patients who have means for support, but who need the care and restraint of an asylum.

We are

Medical men justly deplore the ignorance of the public as to the distinctions between true and false systems of medicine. Let us suggest a simple and effectual method of enlightening the popular mind. During the winter, when popular lectures are so well attended, let the country physician engage to give a series of lectures in his village lyceum, tending to instruct his neighbors in those general principles which underlie scientific medicine. satisfied that physicians may thus not only make themselves useful by the instruction they give, but may establish on a firm basis, in the communities where they are located, the claims of legitimate medicine. The following extract, from the Angelica Reporter (N. Y.), gives an instance in point. The lecturer was Dr. C. M. Crandall, of Belfast, and his lecture is thus flatteringly noticed :

The

"His aim," says the Reporter, "was, on this occasion, to exhibit the absurdity of the theory of that sect of medical practitioners known as homoeopathists, and to our mind he was entirely successful. We cannot here introduce the proofs in support of his subject; suffice it to say, they were authentic and convincing, while his arguments deduced therefrom were clear and forcible. lecture was well written, showing evident marks of scientific learning, and much research in medicine. It was likewise well delivered and entertaining, both in its style and subject matter. The Dr. closed with a few eloquent and exceedingly well-timed remarks, commendatory to the regular medical profession-in which he said substantially, that they were in no sense sectarian-they claimed no one-idea theories, neither did they adhere to the doctrines of any particular man of their profession; but, he was proud to say, they gathered good, so far as practicable, from everything under the sun.'

Reviews.

MALADIES DES FEMMES: LEÇONS CLINIQUES, par GUNNING S. BEDFORD, A.M., M.D., Professeur d'Obstetrique, de Maladies des Femmes et des Enfants, de Pratique des Accouchements, à l'Université de New York; traduit de l'Anglais, sur la 4me edition, et suivi d'un Commentaire Alphabétique, par PAUL GENTIL, Docteur en Medicine de la Faculté de Paris, Ancien Chirurgien et Médecin des Hôpitaux Civiles et des Prisons, etc. Paris, 1860. pp. 658. CLINICAL LECTURES ON THE DISEASES OF FEMALES, by GUNNING S. BEDFORD, A.M., M.D., Professor of Obstetrics and Diseases of Women and Children, etc. Translated from the 4th English edition, with a Commentary, by PAUL GENTIL, Doctor of Medicine of the Faculty of Paris. Paris, 1860. pp. 658.

We have had frequent occasion to notice Prof. Bedford's Clinical Lectures on the Diseases of Women and Children, as the work passed rapidly through its six successive editions in this country. Although the colloquial style of much of the work tended to excite criticism, still it met with more general favor from reviewers than any recent medical publication with which we are acquainted. That it was well received by the profession, these numerous, rapidly issued editions sufficiently prove. Nor was the American Medical press alone in its favorable comments, but the English press contributed to its popularity by the most flattering notices.

Successful as the work has been at home and abroad, we were not prepared to see it achieve a success exceedingly rare in the history of American medical authorship, viz. a translation into the French language. But the work before us proves the fact. We congratulate the author upon this high compliment paid to his labors in the still new field of uterine pathology, where so many struggle vainly for reputation.

The translator, Dr. Gentil, dedicates his work in the following terms, to the memory of his intimate friend, one of the most eminent French surgeons-AMUSsat:—11 m'éclaira souvent de ses conseils, il m'honora toujours de son amitié. In the cursory examination which we have given the volume, we judge that the translator has construed the text literally, adopting in full the colloquial style, which, indeed, is well adapted to the French mode of clinical teaching. Very few notes are found accompanying the text, but forming a supplement, or, as the author terms it, commentaire alphabétique et complémentaire, we have upwards of two hundred pages of new matter. In this part Dr. Gentil has taken up individual subjects in alphabetical order, referring to the page of the work where they have been treated, and discusses them at length in their bearing upon French obstetric medicine. His annotations give evidence of scholarship, and a full appreciation of his subject.