been recognized at the time of the first attempts at reduction that the uterus had not been replaced entire, and if a distinct ring could be felt. He had seen cases where such a ring could be felt. Dr. Putnam stated that it was his opinion that if a uterus were once entirely replaced it did not have a tendency to come down again.

Croton Chloral in Neuralgia. DR. H. I. BOWDITCH reported a case of facial neuralgia which had been relieved in a decided manner and without any unpleasant effect by three five-grain doses of croton chloral, after all other drugs had failed to give relief. - DR. WILLIAMS stated that he had often used it with advantage instead of opium, after operations about the eye. The chloral had no unpleasant effect, and he thought it safer. - DR. J. O. GREEN remarked that he had used this drug at the City Hospital in cases of neuralgia of the head, and had obtained a wonderful effect in one case.

Dysmenorrhea and Tape- Worm.-DR. BIXBY reported a case of a young woman with dysmenorrhoea. Upon her second visit he found that she had a tape-worm. Upon appropriate treatment twenty-five feet of the worm, with the head, was dislodged. Since then the patient has had no dysmenorrhea. — DR. H. I. BOWDITCH said that formerly in all cases of dysmenorrhoea a strong cathartic was administered, and asked if, in view of the above case, it would not be good practice to do so now.

OCTOBER 21, 1878.

Croton Chloral. - DR. BOWDITCH wished to state that in the case of neuralgia reported at the last meeting the pain had par tially returned, and had to be relieved by narcotics and doses of croton chloral, and he did not find that the relief was as permanent as he thought at the last meeting.

Pleuritic Effusion. DR. BOWDITCH said that he had a case of simple non-purulent effusion into the chest. He had drawn off the fluid six or seven times in the previous five weeks to prevent compression of the lung, and three or four months before, after tapping, he heard a rubbing sound throughout the chest to the point of puncture, and thought that it would not fill again; bat after a rest of four months he found the chest refilled. He wished to ask whether he was justified in making a permanent opening in this case of serons effusion, and run the risk of its becoming purulent. He wanted to know if there was any objection to this mode of procedure under the circumstances. There was another reason why this should be done, namely, that within the past month enlargement of the heart had taken place, and he had seen two cases of this character where the patients died suddenly from heart disease.— DE. BRADFORD thought that the dangers Dr. Bowditch spoke of were very much less if the operation were done by the antiseptic method. He had seen many cases of empyema in Lister's wards, and some in the New York hospi tals, and the danger to life was comparatively slight.

Malformation of Ureters. DR. W. H. BAKER read a paper on Malformations of the Ureters, where the left ureter opened in the neighborhood of the urethra, and by operating he connected the ureter with the bladder, with per fect recovery of the patient. The paper was reserved for publication.

Hydrophobia. DR. T. B. CURTIS read a paper on a case of hydrophobia.

with a fatal result, where the patient took thirteen and three quarters grains of Merck's curare in twenty-three hours. The patient continued to the end to display considerable muscular strength in his paroxysmal struggles. - DR. J. J. PUTNAM said that he had been much interested in Dr. Curtis's paper, especially as he had previously had the opportunity of talking with him about it. There seemed to be no question that, as Dr. Curtis had said, the paroxysms were due to inhibition of the inspiratory centre, and he believed that this was due, not to any peculiar susceptibility of the inspiratory centre to inhibitory influences, but to the greatness of the inhibitory stimulus. The reason for this belief is that, as we know from the experiments of Wundt, the power of a nervous centre (or nerve fibre) to respond to an excitation by showing phenomena of inhibition, is one which implies, in proportion to the degree to which it is present, that the nervous tissue is in an efficient and healthy state, and that this is the first physiological property to be lost in case of disease from any cause. With reference to the nature of the powerful inhibitory influence which must be the immediate cause of the paroxysms, Dr. Putnam. thought it was to be traced not to a hyperæsthetic condition of the peripheral nervous system, in favor of the existence of which there is no evidence, but to the peculiar mental condition of the patient; the paroxysms being thus to be regarded as parallel to the state of a person said to be "paralyzed with fear," etc., or that of a drowning man, struggling convulsively, and "catching at straws" for help which is in fact only removed the farther from him by his endeavors.

NOVEMBER 4, 1878. A Complicated Case. The regular reader of the evening, DR. DRIVER, read a paper entitled A Complicated Case:

The patient, a female, having heart disease since girlhood, developed lung difficulty; then suddenly cerebral symptoms showed themselves, which were suspended to allow an attack of typhoid fever to run its course; after which the cerebral symptoms again manifested them selves, and the patient died. At the autopsy, made by Dr. Cutler, there were found a small aneurism the size of a bean in the right anterior cerebral artery filled with a dense laminated clot, and in the right middle cerebral a still smaller aneurism filled with clots, completely shutting off the blood supply to the right corpus striatum. This corpus striatum had softened and become necrosed, and in the latter process a peripheral vessel had been opened, which allowed of cerebral hemorrhage, from which the patient died. There was disease of the mitral valve of long standing, with vegetations and stenosis. Broncho-pneumonia of both lungs, with tuberculosis of one, was found. The spleen was enlarged, with embolic infarctions of old date. In the intestines there were found typhoid ulcerations, with enlarged mesenteric glands. The liver was also enlarged.

DR. MORRILL asked why, in view of the sudden nature of the attack and the existence of heart disease, embolism was not as probable a cause of the brain trouble as tubercular meningitis. — DR. DRIVER replied that the heart disease was of long standing. — DR. MORRILL said that embolism was not usually the result of recent cardiac trouble.

Ruptured Pericardium and Diaphragm. — DR. DRAPER showed a specimen of ruptured pericardium and diaphragm, and gave the following account of the case:

B. McD., thirty-eight years old, a vigorous Irish laborer, was standing upon a low platform at the edge of a sewer excavation, when a cart was carelessly backed against the

stage, throwing it and its occupant into the cut, a fall of twenty feet. The injured man was rescued after some delay, and died in twenty minutes from the time of the fall, having continued in an insensible condition from the outset. At the autopsy, nineteen hours post mortem, the only external signs of violence were some superficial abrasions of the forehead and face, with two small bruises at either side of the sternum, close under the clavicles. After removal of the sternum and costal cartilages a distention of the pericardium was noticed; incision of this part exposed a great quantity of clotted and fluid blood filling the cavity. Four fluid ounces of bloody serum were removed, leaving coagula in masses entangled in the old adhesions of the heart and pericardium. In the parietal por tion of the pericardium, beginning just behind the apex of the heart and passing downward and to the right a distance of four inches, was a laceration involving the pericardium and the upper muscular layers of the subjacent diaphragm. The interventricular septum was also ruptured transversely. The liver showed four small superficial lacerations on the inferior surface of its right lobe. The right kidney presented five superficial tears, half an inch long, near the hilus on the anterior surface. This organ lay in a mass of fat which was much bruised and infiltrated with extravasated blood. The sternum was fractured through the centre of its body. The fifth and sixth ribs on the left side were broken just outside the nipple line. The left tibia and fibula were fractured transversely at their middle.

GREEN'S PATHOLOGY.1

THE present edition appears two years after its predecessor, which has undergone a considerable degree of revision in the way of addition and subtraction. The same peculiarities which were referred to when the previous edition was noticed are still present, and the reader must continue to hope that the literary style of the author may be combined with a more thorough and critical display of his subject.

One of the first changes to be noticed is a different grouping of the several varieties of tumors. This, on the whole, is a change for the better, though it is difficult to understand the reason for placing the myxomata at the end of the list of tumors composed of simple forms of tissue. The consideration of mucous tissue naturally precedes that of other forms of connective tissues, except the fibrous, with which it is so closely related.

Special attention may be called to the introduction of a short chapter on scrofulous inflammation, and to the alterations in the chapters on tuberculosis and phthisis. Greater prominence, though perhaps too great, is attached to the presence of giant cells as a characteristic of tubercles.

The rearrangement of the section on pyæmia and septicemia is to the manifest advantage of the reader, and tends to harmonize the theories of these subjects with the more recent views.

In the consideration of lesions from syphilis the omission must be deemed important where any criticism of Heubner's statement of the characteristic value of endarteritis is lacking. Furthermore, although Klein's paper on the changes occurring in scarlet fever is interesting, and not without value, still it is by no means of sufficient importance to call for the insertion of a section on scarlatinal nephritis. The changes in the kidney in scarlet fever essentially represent a diffuse nephritis, and the latter may result from other causes than the one mentioned.

1 An Introduction to Pathology and Morbid Anatomy. By T. HENRY GREEN, M. D. Lond. Third American from the fourth revised and enlarged English edition. Illustrated. Philadelphia: Henry C. Lea. 1878. Pp. 331.

The chapter on thrombosis is still behind the times, especially in that part relating to the organization of the thrombus. There is no mention of the results of Baumgarten's work, which has done so much to throw light upon the nature of the changes taking place around and in the clot.

A considerable number of drawings, all excellent, have been added to this edition. Figure 73, however, better illustrates the alveolar changes in desquamative pneumonia than it indicates the early appearance of a miliary tubercle. If the tubercle has any characteristic, it is that of circumscribed growth within interstitial tissue. To give this up is to depart from the generally accepted view which elsewhere appears prominent in the book.

It may be stated now as before that "the physician who likes to know something of what has been done will undoubtedly be interested in this volume." It is better than its predecessor as more evenly representing prevailing views, and it helps to pave the way for a comprehensive, exact, and impartial work on pathology and pathological anatomy, which does not yet exist in the English language. R. H. F.

DUHRING'S ATLAS OF SKIN DISEASES.1

THIS part of Dr. Duhring's Atlas presents the portraits of four interesting cases of disease, scabies, herpes zoster, tinea sycosis, and eczema vesiculosum. The first of these affections has become so rare of late years, in this part of the country at least, since immigration has almost ceased, that it is well-nigh impossible to make a clinical demonstration of its features to a class of students. A plate like the illustration here given, in which the author and artist have almost perfectly succeeded in imitating its characteristic minute lesions, becomes, therefore, an important aid in teaching and to the practitioner who has not had opportunity of acquainting himself with their appearances either in foreign hospitals or in past times at home. To picture the burrow of the itch insect successfully is almost an impossibility. The illustration of tinea sycosis, the advanced stage of ringworm of the beard, is remarkably good, the best representation of the disease ever published, we think. A study of it, in connection with the plate of sycosis non-parasitica in Part II., should make the diagnosis between these affections and eczema of the bearded face, so often confounded by the practitioner under the name barber's itch, an easier matter. The variety of eczema here illustrated (vesiculosum) is well chosen, because it is one of the rarest forms met with in practice. Vesicles in eczema, in spite of Willan's classification and the author's statement that they are the typical expression" of the disease, are under our clinical observation the exception instead of the rule. The opinions of the latter, however, upon this point, as well as those expressed in the text concerning the other affections here represented, are of course more fully stated in his textbook, and are not now the subject of critical remark. As explanatory of the illustrations and descriptive of the cases selected, the text is wholly satisfactory.

66

1 Atlas of Skin Diseases. By Louis A. DUHRING, M. D., Professor of Skin Diseases in the Hospital of the University of Pennsylvania, Dermatologist to the Philadelphia Hospital, etc. Part V. Philadelphia: J. B. Lippincott & Co. 1879.

FOX ON SKIN DISEASES.1

IN preparing this edition for publication in the United States the authors state that they have increased the matter to about three times its original amount. and have rewritten it almost wholly. Its purpose, they say, is to afford assistance to the student in his early study of skin diseases, and to serve as a manual for ready reference to the practitioner in his daily practice. If such books are necessary, if these purposes are not better supplied by the more complete works on general dermatology, such, for instance, as the excellent handbook of the senior author, then this one is a success. It presents a very complete outline of modern dermatology, tinged, of course, by the writers' wellknown views regarding classification and pathology, but on the whole fairly and broadly executed. It is such a book of its class as only one competent to write a full treatise upon the subject could have written.

The first part is general in character, treating of methods of observation, pathology, classification, ætiology, diagnosis, and therapeutics. In the second part individual diseases are described alphabetically, and methods of treatment quite fully given, reference being made to the abundant formulæ appended to the volume. Dr. Fox holds and here expresses opinions upon many points in dermatology, which actively invite discussion, but stated as they necessarily are, mostly without argument, they may well be left without discussion, espe cially as they have been amply criticised in connection with former publications. The American editor has inserted some interesting remarks upon peculiarities of skin diseases in the United States, and also the plan of classification and nomenclature adopted by the American Dermatological Association at its last annual meeting.

WOOD'S THERAPEUTICS.2

THE former editions of this work having already received from us extended notices, we merely call attention to the additional matter to be found in this last edition. Professor Wood informs us (page 71) that large doses (ten to twenty grains) of quinine have been proved to produce stimulating effects on the uterus during a protracted labor caused by irregular and feeble muscular contractions, but he attributes this effect to "its arousing the general nervous forces of the system." The articles on jaborandi and its alkaloid pilocarpin, salicylic acid, salicine, dialyzed iron, and thymol contain a very fair epitome of recent investigations. We regret that Professor Wood has not inserted in the text the proper doses expressed in metrical weights and measures, as well as those of the commonly used apothecaries' table. We believe none of the therapeutical text-books in English have as yet introduced this practice, while doubtless the use of the metric system would be greatly facilitated by such an innovation. This work bids fair to keep its position as the best text-book on the action of drugs.

1 Epitome of Skin Diseases. With Formula for Students and Practitioners. By TILBURY Fox, M. D., etc., and T. C. Fox, M. B., etc. Second American edition, enlarged and revised by the authors. Philadelphia: Henry C. Lea. 1879.

2 Treatise on Therapeutics, Materia Medica, and Toxicology. By PROF. H. C. WOOD, JE. M. D. Third edition, revised and enlarged. Philadelphia: J. B. Lippincott & Co. 1879.