hesitation in applying the same irritating substance to the patient's gastric and intestinal mucous membrane, and setting up an irritation which cannot but be hurtful to the patient's chances of recovery. It seems to me that, of the two evils, the constipated bowels are by far to be preferred.

If violent purgatives may do so much harm, the question arises whether we should entirely exclude the use of purgatives from our treatment. I am satisfied that in a large proportion of cases the bowels will act of themselves if left alone, and if no preparation of opium be given. The treatment that I have advocated in this journal and elsewhere, consists of the exhibition of large doses of chloral and Indian hemp: with this I have rarely had occasion to order purgatives, and to this in some measure is probably due its success in my hands. No doubt, however, it is occasionally necessary to open the patient's bowels. He is restless, and complains of abdominal distress, quite distinct from the epigastric pain peculiar to tetanus, and a desire to go to stool without being able to pass any fæces. Under these circumstances only do I consider the administration of laxatives justifiable in acute tetanus. The only one I have prescribed in such cases and can therefore recommmend is castor-oil, in drachm doses, at pretty frequent intervals: it acts without producing abdominal irritation or any general disturbance of the system: it is well to add a few minims of tincture of hyoscyamus to each dose.

With regard to the use of enemata : for obvious reasons they are calculated to do more harm than good, and should be ordered only under very exceptional circumstances, if at all.

The same may be said of hypodermic injections. I have seen cases recorded in which the drugs were administered altogether hypodermically, and the unfortunate patients were literally riddled. In one or two cases it was casually mentioned that each prick of the needle brought on a spasm!

In conclusion, I can with confidence say that never have I had reason to regret that I did not purge a patient suffering from tetanus, but I have more than once had occasion to repent following the practice so emphatically laid down in most, if not all our text-books.

Eyesight: Good and Bad.
Preservation of Vision.

Reviews.

A Treatise on the Exercise and By ROBERT BRUDENELL CARTER, F.R.C.S., with Illustrations. 8vo. pp. 265. London: Macmillan & Co.

In his preface the author states that a large portion of the time of every ophthalmic consultant is occupied, day after day, in repeating to successive patients precepts and injunctions which ought to be universally known and understood. The present work contains an endeavour to make these precepts and injunctions, and the reasons for them, plainly intelligible to those who are most concerned in their observance. Intended, as the work must therefore necessarily be, for many who have had no training either in physics or physiology, it would be impossible for its readers to understand the aberrations of vision, and the reasons given for certain lines of treatment, without a previous knowledge of rudimentary optics and the structure of the eye. The work therefore begins with chapters on the structure of the eye, on light, on the forms and properties of lenses, on the formation of images in the eye, and on refraction and accommodation, before proceeding to discuss abnormal conditions, beginning with presbyopia. Then follow chapters on single vision with two eyes, and convergence: defects of vision produced by faulty shape of the eyeballs; myopia, hypermetropia, and astigmatism: asthenopia, or weak sight: colour, colour-vision, and colour-blindness: the care of the eyes in infancy and childhood: the care of the eyes in adult age; natural and artificial illumination; accidental injuries; the influence upon sight of the general health and habits of living: contrivances for saving visual effort: practical hints on spectacles. Under the head of presbyopia, the author does good service by exposing the falsity of the common and widely spread belief that strong glasses tend to cause blindness-a belief which, sometimes at least, leads people to object to glasses altogether, or to do without them as long as they can.

when their eyesight would be very much benefited by their use. The reason of this belief is that the rapid failure of accommodation is a premonitory symptom of glaucoma, and the demand by persons suffering from this disease for glasses of constantly increasing power led to the belief that the glasses themselves were the cause of the failure of vision. The chapter on "defects of vision produced by faulty shape of the eyeballs, myopia, hypermetropia, and astigmatism," ought to be read, not only by every member of the School Board, but by every one who is interested, either directly or indirectly, in the education of children. There can be no doubt whatever that badly lighted and badly fitted schools are an arrangement for producing myopia. The bad light and bad fittings alone are not to bear the whole blame, although they deserve a great deal. Another cause of the myopia is the feeble and easily extensible character of the tunics of the eye, which allows of their gradually stretching in the antero-posterior direction, and this gives rise to myopia. This debility should be treated not only by food, tonics, and exercise, and an ample supply of pure air to the school-rooms, but also by an abbreviation of the tasks. In an interesting experiment made by Mr. C. Paget, a portion of the children in a school were made to work only half time at their lessons, spending the remaining half in garden work. In a short time these children altogether outstripped, in their school work, those who devoted, or were supposed to devote, twice as much time to it.

The chapter on asthenopia, or weak sight, is also very instructive. It almost always depends on a want of harmony between the effort required for accommodation and that for convergence. It chiefly occurs in patients of the better classes, and sometimes gives rise not only to local irritation of the eyes, but to the fear of serious brain-disease, the mere attempt to read sometimes producing giddiness, headache, palpitation of the heart, and sickness. For such cases complete rest of the eyes is often prescribed, but erroneously; the proper treatment being to correct any defect in the eyes by spectacles, and afterwards to train the muscles of the eyes up to their work by gradually increasing exercise, always taking care to keep it short of fatigue.

In the chapter on care of the eyes in childhood, the author notes that in the experience of ophthalmic surgeons it is exceptional to meet with a child suffering from defective vision who has not, before the defect was discovered, been repeatedly and systematically punished by teachers or schoolmasters for supposed obstinacy or stupidity, whereas the first question regarding the apparently obstinate or stupid child should always be, "Can he see perfectly?"

The work is one which contains, in an exceedingly clear and agreeable form, information not readily to be had in ordinary text-books, and it will be exceedingly useful, not only for lay readers who suffer from defective vision, and to medical men and their patients, but to every one who has anything to do with education.

Practical Histology and Pathology. By HENEAGE GIBBS, M.B. 8vo. pp. 107. London: H. K. Lewis.

THE object of this work is to give the practitioner and student of medicine a few concise and simple methods for preparing various tissues and pathological products for examination with the microscope. The book is no mere collection of various processes given by different people. The author has only given those which he finds by personal experience to be the best, leaving the others out, and thus avoiding the risk of confusing the reader. The chapters on staining are especially full, and in no other work with which we are acquainted will the reader find such ample information upon this important part of the preparation of tissues for the microscope. This little work contains no padding: it consists entirely of precise instructions by one who is evidently master of the subject, and we know no work which we can more highly recommend to either student or practitioner.

Annals of Chemical Medicine; including the Application of Chemistry to Physiology, Pathology, Therapeutics, Pharmacy, Toxicology, and Hygiene. Edited by J. L. W. THUDICHUM, M.D. Vol. I. pp. 356, with several Woodcuts. 8vo. price 14s. cloth.

THE literature of physiology has grown to such large dimensions that any work which is intended to summarise portions of the subject and place them before the general reader in a condensed form is received with welcome. By the term "general reader" must be understood one who, requiring to keep himself au courant with what is happening, is too much occupied professionally or otherwise to be able to read original papers at full length: to such a person a work which adequately fulfilled the functions suggested by the title, Annals of Chemical Medicine, would be extremely useful.

The first volume, of a presumable series, with the above title unfortunately does not carry with it the promise of great utility; and the reasons are not difficult to point out. A very short perusal of the book shows that its intention is to a considerable extent polemical: this is sufficiently indicated in

the preface, where the author speaks in strong, and shall we say unfair, terms of the acquirements and behaviour of those who do not quite agree with him. Nowhere is it better shown, however, than in the chapter devoted to "Protagon." It is customary to give the names of both authors, when quoting a paper which is the result of the conjoined labours of two observers; moreover the tone of the concluding paragraphs is scarcely appropriate when speaking of investigators who are regarded with respect by their fellow-workers.

The first two and other chapters devoted to points in connection with the chemistry of proteids are good, and will be read with interest; this is especially the case with the account given of Schützenberger's valuable researches on the decomposition of proteids. Chapter III., treating of the action of ferments on starch, and the pages devoted to chitin, require some mention; and of these the references to past researches will be found to be by no means the least valuable. The portion which treats of the bile-pigments is useful, as containing in a compact form the author's own experiments and views on these bodies. The last chapter is purely controversial on the same subject. The life of Mayer, though interesting, is perhaps a little out of place.

We are sorry not to have been able to accord greater praise to this book, since there is need of a work of its kind. The controversial nature of the contents is somewhat opposed to the title; and the latter should be altered if the author intends to use this work so largely as a means of enunciating his own special views and, in some cases, of disparaging those of others. Fistula, Hæmorrhoids, Painful Ulcer, Stricture, Prolapsus, and other Diseases of the Rectum, their Diagnosis and Treatment. By WILLIAM ALLINGHAM, F.R.C.S., Surgeon to St. Mark's Hospital for Fistula, &c. Third edition, partly re-written. 8vo. pp. 325. London: J. and A. Churchill, 1879.

Cancer of the Rectum, its Pathology, Diagnosis, and Treatment. By W. HARRISON CRIPPS, F.R.C.S., Surgeon to the Great Northern Hospital, &c., &c. Fcap. 8vo. pp. 191. London: J. and A. Churchill, 1880.

IN the third edition Mr. Allingham has added considerably to some parts of the former work, but has not impaired its usefulness as a practical manual. The treatment of hæmorrhoids, and of hæmorrhage after ligature of hæmorrhoids, is especially valuable, for it is evidently written by one who has himself felt and conquered the difficulties of which he writes. In the treatment of fissure of the anus the author has lately substituted for the cutting operation dilatation of the sphincter, modified.