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manufacture of artificial mineral waters, their use had become Ialmost universal. The author then said that, although a largenumber of eminent men of science had directed their study tothe nature and action of the spas, there were still many pointson which most erroneous impressions existed with regard tothem, and in which the prevailing inclination to look beyondthe boundaries of physical laws was strongly manifested. Oneof these was the temperature of the springs, it being believed Ithat the heat possessed by certain waters was not identicalwith ordinary heat, but possessed peculiar properties. The Ireason for first assuming a difference between the two was thecircumstance that the indifferent thermal springs-namely, suchas contained scarcely any foreign ingredients-were proved topossess most remarkable curative properties, which did notbelong to ordinary waters of the same temperature, and whichwere believed to be due to the peculiar kind of heat inherentto the spas. The author then discussed the several pointswhich ought to be borne in mind in conducting experiments onthe heat of the mineral springs. There were the influences ofconduction, radiation, and evaporation to be taken into account,if we wished to compare the cooling of identical liquids whichpossessed the same amount of caloric. Different liquids, how-ever, possessed a different degree of specific heat, and waterwould cool differently according to the quality and quantity ofsolid and gaseous ingredients it contained. It was thereforenot to be expected that mineral water should lose its heat inthe same proportion as ordinary water. If water containedsalines in solution, the evaporation was diminished, the boilingpoint became higher, and the freezing point lower. When due

regard was paid to all these circumstances, it was found that afundamental difference between the two kinds of heat did notexist.The author then considered the part played in mineral

waters by carbonic acid, which not only greatly contributed tothe solubility of certain salts contained in the water, but alsorendered them more palatable and more agreeable to thestomach. Carbonic acid was found in the springs, either free,as gas, or bound to certain bases, with which it formed car-bonates, sesquicarbonates, and bicarbonates. The amount ofit contained in the waters was dependent upon several con-ditions, the chief of which were hydrostatic and atmosphericpressure and the degree of temperature. The more or less in-timate connexion of carbonic acid with certain mineral watershad been made the subject of much mystical misrepresentation.No doubt the gas appeared loosely bound to some, and firmlyimpregnated in other, mineral waters; but such phenomenacould always be explained in a scientific manner. Where tem-perature and pressure were not sufficient to account for them,they were generally connected with the specific gravity of thewater, or with the circumstance whether other gases were keptin solution or not. The sources from which the waters derivedtheir carbonic acid were of various kinds; the most material ofthem was, however, the decomposition of limestone (which,together with silica, formed the greatest portion of the solidcrust of the earth), partly by sulpliuric and hydrochloric acids,which existed in the interior, and partly by a simple processof calcination, due to the subterranean heat, and which wasassisted by the presence of aqueous vapours. An outlet was

provided for carbonic acid, thus formed, by volcanic agency,through which the crust of the earth was torn asunder, andthe impediment to the free escape of the gas from the interiormay talzan away

The author then gave a short account of the more remark-able aciclulated mineral springs of Germany, France, Italy, andGreece; and said that the phenomena observed in such placeswere so remarkable, that we could not he surprised to find anuneducated age and people looking upon them as manifestationsof supernatural powers. The hissing, whizzing, and gurgling 0sounds occasioned by the discharge of the gas were by theancients believed to be the voices of demons: it w as on placeslike those described, the " spit-acula orci," that, according toHomer and Virgil, Odysseus and -"Eneas went to the lowerworld to meet the spirits of the departed, and that oracleswere founded, which were used by the cunning priesthood todeceive the vulgar.The next subject introduced was the physiological action of

Carlsbad water. The author said that, in judging of the thera-peutical action of the spas, the mistake was frequently com-mitted of merely taking into account the principal constituentsof the water, and of concluding from their known medicaleffects upon the action of a special spa in which they predomi-nated. A mineral water was a complex medicine, which hada peculiar mixture, a certain temperature, and in which a greatv"r:ety of solid and gaseous constituents were intimately blended

together. The only means to arrive at a satisfactory explana-tion of the curative effects produced by them was, therefore, tostudy their action when administered to healthy subjects, andto draw our conclusions from the physiological effects whichthese waters produced. He did not mean to say that we shouldlimit the employment of the waters to such diseases only inwhich, from their physiological effects, they appeared likely toprove beneficial, as we should then unnecessarily restrict theiruse. There could be no doubt that we were justified in admi-nistering them in all cases in which experience showed them tohave been successful. But this did not diminish the importanceof physiological researches; it should rather be a stimulus to useto endeavour to bring, by continued experiments and observa-tion, both physiology and therapeutics more and more in accord-ance with each other. The principal results of a series of phy-siological researches undertaken with Carlsbad water by Prof.’ °

Scegen, of Vienna, were then given, especial regard being paid- Tto the quantity of the feeces, the quantity and the composition* -of the urine, and the weight of the body.The author concluded his paper with some remarks on mineral’’’

waters containing lithia; and adverted to the researches under-taken on this substance by Lopowitz, Mr. Alex. Ure, and Dr.Garrod. Quite recently, Professor Bunsen, of Heidelberg, hadshown, by a new method of qualitative chemical analysis, thatxlithia was a substance most universally encountered in nature,being contained, not only in a large number of minerals, butalso in sea-water, in certain woods, in fucus, in the ashes oftobacco, of grapes, of vine-leaves, of corn. of milk, of the humanblood and muscles. The most considerable quantity of it was,however, found in two of the thermal springs of Baden Baden,in one of which two grains and a third of chloride of lithia. werecontained in sixteen ounces of water, representing nine poundsthree quarters in a hundred pounds of the salt extracted fromthat spring-that is, a quantity of lithia worth X90 sterling.In consequence of the analysis made by Professor Bunsen ofthese springs, they had, during the last season, for the firsttime been extensively used in cases of gout and uric-acid dia-

thesis. Dr. Ruef, of Baden-Baden, had communicated to Dr.Altbaus the results of his experience with these waters, whichwere highly satisfactory, as many cases of gouty affections ofthe joints and the sheaths of the nerves and muscles had beencured by them within three or four weeks.A discussion followed, in which Dr. Edward Smith, Dr.

Thompson, and some other members of the Society, took part.

JUNIOR MEDICAL SOCIETY OF LONDON.

THURSDAY, OCT. 24TH, 1861.MR. FAGGE IN THE CHAIR.

AT a meeting held at Guy’s Hospital, Mr. WEAVER (Guy’s)read a paper on

JAUNDICE.

Cases of jaundice, he said, are divided by Frerichs into thoseof obstruction in the biliary passages, and those where there isno discoverable obstruction. The former class include caseswhere there is constriction of the common bile duct, closure ofthe common or hepatic dnct, constriction of the liver, or closureof the ducts within the liver itself. £ Constriction of the com-mon duct occurs in jaundice from catarrh; from pressure, as ofthe gravid uterus or impacted faeces in the colon; from glandsin the liver fissure enlarged by laidaceous, tubercular, or can-cerous infiltration; and from gall-stones. A case of lardaceousliver and jaundice was well exemplified in a girl aged eighteen: ethe liver had been enlarged for seven years; jaundice hadexisted for one year. As an instance of gall-stones causingobstruction, thu author cited the case of a woman who had

previously suffered from calculus of the kidney and haematuria:the jaundice was too intense to be the result of renal irritation ;she suffered paroxysms of ngonizing pain; improvement in fourweeks. The effects of obstruction in the biliary ducts wereconsidered. The bile, unable to find exit into the duodenum,is reabsorbed. The liver-cells are still performing their func-tion, as bile does not pre-exist in the blood. The epitheliumof organs and the epidermis are the agents for the excretion ofbile pigment in jaundice. Absence of bile from the intestinesinduces the paleness and fetor of the faeces, and also constipa-tion. Long continued obstruction produces dilatation of theducts and of the gall-bladder, and for a time enlargement ofthe liver. The correctness of the statement that in these casesthe liver-cells disappear, leaving only granules. is denied byDr. Wilks. Ulceration, abscess, and peritonitis may ensue.

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’For instance, a woman aged fifty had symptoms of gall-stones,then jaundice with pyrexia, and enlargement of the liver;death resulted. At a post-mortem examination, the liver wasfound riddled with abscesses, the ducts were greatly enlarged,and small gall-stones were impacted in the common duct. Themain duct may be closed by various causes, as cancer of thepylorus, duodenum, or pancreas. The ducts within the liveritself may be obstructed by cancer, hydatids, or inflammatorydeposit, by a mass of dead membrane passing down the hepaticand common ducts, by cirrhosis, and by congestion of theliver, the minute bile-ducts being obstructed by distendedbloodvessels. The author recorded cases of most of these formsof obstruction. Passing on to the cases where no obstructionis discoverable, we have the effects of mental emotion, pyaemia,,fevers, &c. In a case of jaundice from pyaemia superveningupon ulceration of the rectum, the liver was found to be green,and studded with white spots from pus; and jaundice fromsVDhilitic caries of the frontal bone was cited as having occurredin a case of pyae01ia. Of acute yellow atrophy of the liver, inwhich there were most severe symptoms and acute jaundice,there are three preparations, the author said, in the Guy’sHospital museum; the livers weighed respectively 2lbs. 2 oz.,1 lb. 3 oz , and 1 lb. 9 oz. Frerichs’ theory of these cases isthat the acids of the bile get changed in the blood into bile-pigment.An animated discussion ensued, in which the following

members took part:-Messrs. Galton, Clarke, Yeo, SydneyTurner, Hindle, Meadows, Pye Smith, Best, Hilles, andStevenson.

Mr. MoRTON (St. Thomas’s) exhibi:ed a specimen of BronzedSkin in connexion with Snpra-Renal Capsule Disease.Mr. TpEWHELLA (Guy’s) exhibited a specimen of Ulceration

of the Fauces after Scarldt Fever; and also a portion of Lungof the same patient, showing the three stages of pneumonia.Mr. WhAVER having replied, a vote of thanks was unani-

mously returned to him for his interesting paper.The next meeting of the Society will take place at the

London Hospital on the 21st of November.

Reviews and Notices of Books.A System of Sur{Je1’Y, Theoretical and P9’aCtiCal, in Treatises

by vaJ’io1l8 Authors. Edited by T. HOLMES, M. A. Cantab.In Four Vols. Vol. II.: Local Injuries; Diseases of theEye. London: Parker.

[SECOND 2:OWCE.Iy pursuance of the design expressed in our first notice, we

proceed to examine more critically the separate articles whichcompose this volume. It opens with an essay on " Gun-shot

Wounds," by Mr. Longmore, the Professor of Military Surgeryat Fort Pitt. The author speaks with all the authority whichan intimate acquaintance with his subject and personal expe-rience of the recent wars can give. His contribution notonly indicates the progress of military surgery, but lends datato civil surgeons. Sir Astley Cooper said that the experienceof the Peninsular War gave an unprecedented impulse to sur-gery ; and although the sagacity of a Hunter or a Guthrie isnot always at our service, we may anticipate useful teachingsfrom the stern lessons of every campaign. One of Hunter’sfavourite doctrines-that amputation should not be performedafter gun-shot injuries until the first inflammation was over,since it was " a violence superadded to the injury"-we havecompletely unlearned on the field of the Crimea. Guthrie had

already called it in question on the ground of his Peninsularobservations, and in both the English and French armies in theCrimean campaign the success of primary amputation greatlyexceeded that of secondary amputation-sometimes by as muchas two-thirds. The modern practice is, then, to perform neces-sary operations as soon as possible after the first intensity of, shock" has passed off. The great success of this practice ispartly due to the benignant influence of chloroform, negativelyin preventing pain and alarm, and positively in its action as astimulant. The experience of all the recent wars has shownthat chloroform is quite applicable to operations after gun-shotwounds; and that while hundreds owed their lives to the faci-

lities which it affords for successive and multiple operations, fordiminishing shock, and for completely examining severe inju-ries, accidents were unknown after its use.Modern improvements in projectiles have modified the aspect

of military surgery. The number of wounded is now enor-

mously greater in proportion to the strength of the army.Colonel Welford stated recently in public that 80,000 roundsof ball cartridge were fired in Caffraria from the old musket inone day, and only twenty-five Caffres were known to be hit;while at Cawnpore, one company of soldiers brought downsixty-nine horsemen at a single discharge of their Enfield rifles.At Solferino, 38,000 men were laid h01’8 de combat in twenty-four hours. This increases the strain on the resources of the

army surgeon to an immense extent. The wounds caused bythe conical rifle-bullet differ from those of the old circularbullet in some important respects. From the velocity of thebullet, it rarely happens now that the ball lodges. Then again,in lieu of the strangely circuitous course often taken by thehalf-spent ball of the old Brown Bess, the rifle-ball takes com-monly a direct course. From its wedge-like shape and screwmotion, it splinters and comminutes the bones to a greater extentthan hitherto; thus the joints are often indirectly implicatedby fissures spreading into them. Although the lodgment ofballs is less to be expected, Mr. Longmore does not omit toenforce the necessity of patiently investigating this point inall doubtful cases; mentioning particularly that case, so wellknown now, in which a bullet entering the loin passed throughthe body of a lumbar vertebra, reached the bowel, and wasultimately discharged per anum, the patient surviving for someyears. The old distinctions between apertures of ingress andegress are diminished now; Mr. Longmore’s remarks on thispoint (p. 25) are important to adepts in juridical science. Whenthe muzzle of the weapon is applied close to the skin, as insuicidal wounds, a circular hole without puckering or inversionof the skin, together with dark discoloration of the integumentfor several inches round, are observed at the wound of entrance;when the wound is inflicted from a distance, the opening isirregularly circular, with the edges a little torn and the wholewound slightly inverted.

Passing to the description of regional injuries, the authordiscusses with great ability and clearness the recent views asto the extent to which resection and excision may be carried,quoting a very striking case in which great muscular power re-mained in an upper extremity from which the whole of theulna, two inches of the humerus, and the head and neck of theradius were removed ! Trephining, formerly so general in gun-shot injuries of the skull, is severely criticized as a dangerousand rarely useful proceeding. Only in four cases was it suc-cessfully applied in the Crimean War (and none of these werefrom rifle balls). This part of the essay will be read with par-ticular interest. In matters of treatment, a general agreementprevails with civil surgery. We must venture, however, toquestion the partial approval which Mr. Longmore accords tovenesection in penetrating gun-shot wounds of the chest, espe-cially when he says that " where hasmorrhage is manifestlygoing on internally, it may be practised with a view of drawingblood from the system, and more speedily inducing faintness, togive an opportunity to the pulmonic vessels to become closed."

"Injuries of the Head" are discussed by Mr. Prescott Hewettwith a minute and skilful judgment, which accords with hisknown devotion to the study of this department of surgery.Trephining comes again under review. Five times out of eightPott successfully trephined for abscess between the skull anddura mater; but no such success has followed those who imi.tated his practice. Mr. Hewett believes that the successfulissue in such cases is all but unknown to surgeons in our time.The rul2s for applying the trephine are, therefore, defined withjealous care, as also those for diagnosing, and thus setting freeextravasation of blood between the bone and dura mater. Inthe treatment of fractures of the vault of the skull, Mr. Hewettlimits the immediate indications for operation to the case of