II. The number of cases of sickness and vomiting is about the same with the two agents, but the duration is considerably protracted in the case of chloroform; the occurrence of these symptoms have no relation to the length of time the patient has been under, or reference to the quantity of anaesthetic administered in a given time.

III. With both agents, the pulse-respiration ratio is considerably altered in a certain number of cases, the pulse falling as the respirations increase in frequency. With chloroform, this change is not only much more marked, but its occurrence is also more frequent than with ethidene; the proportion in our experience, being nine of the former to two of the latter. There is also a greater tendency in cases of chlorofom to retardation of the heart's movements, and to dicrotism.

B.-PHYSIOLOGICAL.

I. The effect of anesthesia with chloroform is to increase the amount of carbonic acid exhaled in a given time. The results of our investigations, in connection with the effects of anesthetics on the gases of the blood, are not sufficiently reliable to permit us to give results.

II. Both chloroform aud ethidene, administered to animals, have a decided effect in reducing the blood-pressure; while ether has no appreciable effect of this kind.

III. Chloroform reduces the pressure much more rapidly, and to a greater extent than ethidene.

IV. Chloroform has sometimes an unexpectel and apparently capricious effect on the heart's action, the pressure being reduced with great rapidity almost to nil, while the pulsations are greatly retarded, or even stopped. The occurrence of these sudden and unlookod-for effects on the heart's action seems to be a source of serious danger to life-all the more that, in two instances, they occurred more than a minute after chloroform had ceased to be administered, and after the recovery of the blood-pressure.

V. Ethidene reduces the blood-pressure by regular gradations, and not, so far as observed, by these sudden and unexpected depressions.

VI. Chloroform may cause death in dogs either by primarily paralyzing the heart or the respiration. The variations in this

respect seem to depend to some extent on individual peculiarities of the animals; in some the cardiac centres are more readily affected, in others the respiratory. But peculiarities in the condition of the same animal very probably have some effect in determining the vulnerability of these two centres respectively; and they may both. fail simultaneously.

VII. In most cases, respiration stops before the heart's action; but there was one instance in which respiration continued while the heart had stopped, and only failed a considerable number of seconds after the heart had resumed.

VIII. The use of artificial respiration was very effective in restoring animals in danger of dying from the influence of chloroform. In one instance its prolonged use produced recovery even when the heart had ceased beating for a considerable time.

IX. Under the use of ethidene, there was on no single occasion an absolute cessation either of the her rt's action or of respiration, although they were sometimes very much reduced. It can, therefore, be said that, though not free from danger on the side of the heart and respiration, this agent is in a very high degree safer than chloroform.

X. In regard to the effect of anesthetics upon the pulmonary circulation, as in the experiments on the effects of the anaesthetics upon the blood-pressure, it may be stated that chloroform produces the most immediate effect, ether the least, whilst ethidene occupies an intermediate position.

XI. The quantity of air, and the length of time required to restore the circulation in the lung, are in an inverse ratio to the amount of anæsthetic vapor, and time necessary to stop it.

XII. The changes produced in the lung are the same in all; the only difference being in the rapidity of their occurrence.

XIII. The anesthetics produce the following changes in the lungs (1) retardation and ultimate stoppage of the circulation in the lung; first, in the capillaries, then in the arteriole, and subsequently in the larger vessels; (2) the epithelium-cells of the meshes and their nuclei are no longer apparent; (3) the capillaries contract slightly, and their walls become less distinct, or even disappear from view, and the enclosed corpuscles may become more or less disintegrated.

XIV. The effect of ether and ethidene upon the heart, after artificial respiration for seven and five minutes respectively, is simply to produce a retardation of the impulses-ethidene having the most marked effect. Chloroform not only produces a retardation of the pulse, but the ventricular contractions are delayed and slightly separated from the auricular, and an auricular contraction may immediately follow the ventricular. The auricular contractions frequently occur without any corresponding ventricular movements.

C.-PRACTICAL.

The conclusions to be drawn from the above observations are these :

I. It is not only necessary to watch the effect of the anaesthetic upon the pulse, but it is also requisite to have regard to the respiraWe must not only take into account the danger of sudden. stoppage of the respiration, but must also remember that, in the event of abnormal increase of respiratory movements, it may become essential, for the safety of the patient, to temporarily discontinue the administration.

II. Owing to the tendency of chloroform and ethidene-particularly chloroform-to reduce the blood-pressure suddenly, not only during the administration of these agents, but also after they have been stopped for some little time (a source of serious danger), it is necessary for the person who has charge of the administration of the drug to be on the lookout for symptoms of this occurrence, both during the time the agent is being given, and for some time after the patient has recovered from its more evident effects.

III. The danger of death, from stoppage of the respiratory functions, must be borne in mind in every case in which anesthetics are given; but, of perpaps greater importance is the danger from interference with the proper action of the heart-particularly when it is remembered that, by artificial means, we can combat the former contingency. It might even be advisable, in certain cases, to introduce a tracheal-tube by the mouth-so a to enable us to force air into the lungs by means similar to those adoptel in experiments with the same object in view. Artificial respiration should be continued, even though all evidence of cardiac action has ceased.

IV. As regards comparative danger, the three anæsthetics may be arranged after the following order: chloroform, ethidene, ether;

and the case with which the vital functions can be restored may be conversely stated, thus: the circulation is more easily reëstablished when its cessation is due to ether than to ethidene; and when the result of ethidene, than when chloroform has been used. The advantages which chloroform possesses over ether-in being more rapid in its action, in the complete insensibility produced by it, and the absence of excitement or movements during the operation-are more than counterbalanced by its additional dangers.

V. The chief dangers are: (1) sudden stoppage of the heart; (2) reduction of the blood-pressure; (3) alteration of the pulse-respiration ratio; and (4) sudden cessation of the respiration. The danger with ether approaches from the pulmonary rather than from the cardiac side-so that, by establishing artificial respiration, we have a means of warding off death. Its disadvantages are, to a great extent, obviated by the use of ethidene; whilst the dangers of chlorofcrm are also reduced to a minimum.-The British Medical Journal.

WHO FIRST DESCRIBED MALARIAL PUERPERAL

FEVER?

Some correspondence has appeared in the Virginia Medical Monthly upon the above topic. Dr. Hugh M. Taylor claims that the malarial puerperal fever was first discovered by Dr. O. F. Manson, twenty-five years ago, in the Virginia Medical and Surgical Journal. Regarding this claim Dr. Theophilus Parvin writes: "So far, so well. But were there not heroes before Agamemnon?" He then gives quotations from various old works tending to show that as early as 1775 Dr. Butler wrote upon the disease in question; that in 1824 Dr. Blundell, and in 1828 Dr. Burns did the same thing. Dr. Parvin also states that the malady had long been recognized by old practitioners in the West.

In reply to Dr. Parvin, Dr. Taylor reasserts his claims for Dr. Manson, and analyzes the alleged descriptions of the disease by older writers. On the whole, he makes out a pretty strong case for Dr. Manson. Puerperal malarial fever may have been known and treated before 1855, but Dr. Manson seems to have been the first to describe it distinctly.

REVIEWS AND BOOK NOTICES.

PHOTOGRAPHIC ILLUSTRATIONS OF CUTANEOUS SYPHILIS. By GEORGE HENRY FOX, A. M., M. D. Clinical Lecturer on Diseases of the Skin. College of Physicians and Surgeons. New York, &c.

The illustrations in this work will comprise forty-eight plates colored from life. This is the prominent feature of the work. The illustrations are artotypes done by Harroun and Bierstadt, and are colored by hand. Those of our readers who were subscribers to the "Photographic Illustrations of Diseases of the Skin" by the same author, will know how to value the illustrations in the present series, when we say that the improvement here has been great, notwithstanding the former work exceeded all expectations when it was issued.

We have before us Parts I, II, III, containing plates of the following subjects: Two of Syphiloderma Erythematosum; plate 3, two figures post-syphilodermic pigmentation and achromia; plate 4, Syphiloderma Erythematosum, plate 5, Papulous syphiloderm ; plate 6, Syph. papulosum miliare; plate 7, Papulo-squamous syphiloderm in two figures; plate 8, Papulous syphiloderm; plate 9, Circinate papulous syphiloderm; plate 10, Papulo-squamous syphiloderm; plate 11, Papulo-pustulous syphiloderm; plate 12, Pustulous syphiloderm.

Reference to the contents of future numbers gives promise of a valuable series.

The text of the work deserves some comments.

We are glad to see that Dr. Fox, properly values the teachings of the old syphilograpers. We do not think as a clear a conception of the subject can be gained in any way as well as by reviewing the teachings of John Hunter, and others, in connection with the writings of the modern masters. "While it may be pardonable," Dr. Fox says, "to smile at their blunders, or to shudder at the cruel treatment imposed upon those whom they strove to benefit, let us not forget to accord them a tribute of gratitude for our indebtedness, and to think, and to speak of them with reverence which is befitting the grandeur of their achievements."

The second Chapter is devoted to the "Examination of Patients."