this line of treatment properly and firmly may spend their time either in their berths or on deck, as may be most agreeable to them. They can eat what they like best, and take their meals either on deck or below.

In his preface the author asks the readers of this work to tell him whether they find any other bromide or composition with bromide preferable to the bromide of sodium which he recommends, and whether any other powerful nerve-sedative, such as Hyosciamin, may not in some cases take the place of the

bromides.

Hay Fever; its Causes, Treatment, and Effective Prevention. By CHARLES HARRISON BLACKLEY, M.D. Second edition, revised and enlarged. 8vo. pp. 281. London Baillière, Tindal,

and Cox.

IN the first edition of this work Dr. Blackley propounded the view that hay fever was due to the irritation of the nasal mucous membrane by pollen grains which had settled upon it and begun to send out pollen tubes into its substance, just as they would have done if they had fallen upon the stigma of a plant. In this edition he reviews the opinions held regarding the causes of hay fever, and gives an account of his experiments on the effect of benzoic acid, coumarine, odours of various kinds, ozone, dust, pollen, and light, and heat in producing hay fever. His experiments with benzoic acid give an entirely negative result, as do those with coumarine, an odoriferous principle found in some grasses, and in plants belonging to several natural orders. Odoriferous principles produce various results. The odour of camomilia, for example, causes frontal headache, nausea, and giddiness, but no symptoms resembling hay fever. The inhalation of the spores of a microscopic fungus (penicillium glaucum) brought on a severe attack of hoarseness, passing into complete aphonia, and ending in a sharp attack of bronchial catarrh. The result of these experiments to some extent agrees with the observations of Dr. Salisbury, who states that he has seen mould generated on damp straw produce many of the symptoms of measles amongst the troops engaged in the American War. The occurrence which first drew the author's observation to pollen as a cause of hay fever was his noticing that, at certain periods of the year, the inhalation of dust produced hay fever, and one day a carriage which passed him in a narrow lane raised a cloud of dust which brought on a violent attack of sneezing, continuing for about an hour. On passing over the same road the following day, he found that by means of a little of the dust he could again bring on the attack.

Microscopical examination of the dust which had this effect showed it to contain a large number of pollen grains. On then making a series of experiments by applying the pollen of various plants to the nasal mucous membrane, he found that it possessed the power of producing hay fever, both in its asthmatic and catarrhal forms. This power, with rare exceptions, is possessed by the pollen of almost all the plants experimented with. Those belonging to the natural order of graminacea have it in a marked degree, but there are plants belonging to other orders which have it almost, if not quite, to an equal extent.

The disturbance caused by the pollen is due partly to its mechanical and partly to its physiological action. If the vitality of the pollen is partially destroyed before it reaches the mucous membrane, both actions are more or less prevented.

Another cause of hay fever is said to be the odour given off by certain animals; the author thinks, however, that many of those instances are due to the presence of pollen grains in the hairs of cats, rabbits, or guinea-pigs, and that these, and not the odour proceeding from the animals themselves, are the true cause of the disease. Light and heat, although they may have some power to aggravate, do not produce the malady.

1

In this edition the author takes up two most important questions which were left unsettled in the first. One of these related to the quantity of pollen necessary to produce hay fever, and the other to the treatment and prevention of the malady. From a number of experiments the author concludes that less than both of a grain of pollen inhaled in each twenty-four hours suffices to bring on the malady in its mildest form, and 3427th of a grain will keep it up in its severest form. He finds that quinine, applied in the form of a saturated solution to the nostrils several times a day, according to Binz's plan, gave no relief, but rather increased the irritation, and salicylic acid and salicylate of soda were also useless. Bromide of potassium slightly delayed the attacks, but was of little service, nor were the iodide of potassium or iodide of mercury of any greater value. The author seems to believe in homœopathic doses of arsenite of quinine, and uses it in doses of 100th of a grain four times a day. When increased tooth of a grain four times a day, he states that it caused a mild degree of cinchonism, an assertion which rather inclines us to take, cum grano salis, the other remarks of the author. He recommends that the patient should avoid the inhalation of dust as much as possible, and to relieve the irritation of the eyes and face by bathing them first in tepid and then cold water several times a day, taking care to include in the process those parts of the hair that are exposed to the atmosphere. The hair forms an efficient covering round the pollen, and when disturbed will give rise to

irritation when it comes in contact with the eyeball.

He also recommends a lotion, consisting of ten grains of sulphate of copper to three ounces of rose water and twelve of distilled water, or of sulphate of zinc in a somewhat weaker solution.

The other recommendations of the author refer to treatment with homoeopathic drugs, and we therefore think it utterly useless to give them.

The Surgeon's Pocket-Book.

By Surgeon-Major J. H. PORTER, late 97th Regiment, &c. Second Edition, Revised and Enlarged. Charles Griffin and Co. 1880. 16mo., pp. 319. It is with an unfeigned feeling of satisfaction that we greet the appearance of a second edition of this little book, which, although enlarged, may still fairly claim to be a pocket-book. The wondrous amount of information it contains, the illustrations numerous and truthful, the diet-scale and formulary, all contribute to render it the most perfect work of its kind. It may be recommended not only for military but for civil practice, but of course is better adapted to the requirements of the former. There is but one regret which is associated with this edition, the regret that he, to whom we are indebted for it, has ceased to dwell among us, and that his useful and energetic life has not been longer spared to the service of which he was so bright an ornament.

Surgical Emergencies. By WILLIAM PAUL SWAIN, F.R.C.S., Surgeon to the Royal Albert Hospital, Devonport, &c. Third Edition. London: J. & A. Churchill. 1880. Fcap. 8vo., pp. 220.

A BOOK admirably adapted to the purpose it is intended to serve, and most valuable to those engaged in civil practice. The only suggestion we are tempted to make is that Mr. Swain should in future adopt the modern practice of speaking of the more movable or more distant bone as the dislocated bone.

On Aneurism: especially of the Thorax and Root of the Neck. By RICHARD BARWELL, F.R.C.S., Surgeon to Charing Cross Hospital. With illustrations. London: Macmillan and Co. 1880. Crown 8vo. pp. 118.

THE greater part of the contents of this book has already been published in the Transactions of the Medico-Chirurgical Society, (vol. lxii.). But even if no new matter had been added, the importance of the subject would amply suffice to justify a separate publication. That Mr. Barwell has met with a marvellous success in the treatment of aneurism at the root of the neck by the distal ligtaure, cannot be contested, and a careful study of the

cases he has reported leads one to believe with him that success has been mainly due to very careful antiseptic dressing, and to such cautious application of the ligature that the inner coats of the arteries were not damaged. It must, however, still be left for experience to decide whether catgut or the aorta of an ox is the more reliable material for ligatures, for Mr. Barwell's successes were obtained with both. We think the author might be a little more explicit in his directions with regard to the thickness and width of the ribbon ligature on which he lays so much weight. May we also suggest that the name of the distinguished professor at Kiel is Esmarch, not Esmarsch?

Clinic of the Month.

The Treatment of Asthma.-Dr. Berkart states that the most common and severe form of asthma is oedema of the lungs, as it occurs in the obese and the cachectic, as well as in those suffering from valvular lesions of the heart, from gout, and from renal disease (uræmic asthma). It is invariably the result of a temporary failure of the left ventricle, while the right is still able to act and develops itself, either in the midst of apparently perfect health with the suddenness of a fainting fit, or as a rapid exacerbation of an existing cardiac derangement. To understand its pathology, it is well to remember that constitutional and local causes tend to impair the nutrition of the cardiac muscles to an extent varying from the cloudy swelling of the individual fibre to its brown atrophy or fatty degeneration. The heart, notwithstanding these changes, continues to perform its function in accordance with the requirements of the organism, and without painful perception of the patient. It is only when an increased demand is made upon its energy, and on the accession of an irritation, that the organ manifests its inherent weakness, by its inability to meet the one and to resist the other, even if both are so slight as to be powerless to cause disturbance in a healthy person. Edema is thus readily produced by imperfect ventilation of the lungs, as it arises from the rapid extension of bronchitis, from embolism of a large branch of the pulmonary artery, and from excessive meteorismus. The reason is that the blood, abnormally rich in carbonic acid, irritates the centres of circulation and respiration, and that finally while the right ventricle is able to empty part of its contents into the pulmonary artery, which possesses no tonus, the left is incapable of doing so on account of the increased tension of the systemic vessels. In these circumstances the subcutaneous injection of one-sixth of a grain of morphia acts like a charm. As soon as the morphia is absorbed, which requires a longer time than in health, the painful oppression at the chest and the hacking cough disappear: the noisy and