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countrymen, but from Kirkes, Stokes, Watson, Bellingham,and a vast array of German authors. He remarks, at theconclusion of his account of the pathology of acute endo-carditis, that "it is the paresis of the heart which constitutesthe actual danger of endocarditis, as valvular lesions formthe ultimate danger." He observes also that the "func-tional disturbances and subjective symptoms of endocarditishave no characteristic features, and that most of them ap-pear either isolated or combined in other diseases of theheart and of its envelopes, or even in the affections of dis-tant organs. It is then upon the physical signs alone thata diagnosis can be founded, for the antecedent symptomscan only furnish presumptions on the nature and seat ofthe lesion." This is in accordance with the observation of

Stokes, that the symptoms of pericarditis and of endo-carditis so closely resemble one another that they can oftenonly be distinguished by auscultation and percussion.The signs recognised by these means are remarkably wellgiven. M. Jaccoud admits the existence of presystolic bruitin mitral disease, and has carefully collected the numeroussecondary affections that result from the infarction of

different arteries by the detachment of vegetations, as

pneumonia, swelling and inflammation of the spleen, acuteatrophy of the liver, cerebral disease, &c. The treatmentis very briefly given, having been already considered atlength in a former volume, where the therapeutics of cardiacdiseases constitute a special article.The section on the Entozoa, by MM. Leon Vaillant and

A. Luton, the former taking up the natural history and thelatter the pathology, is carefully drawn up, and gives thereader concise information on all the advances that have ebeen recently made. We notice that the Spiropteris homi-nis, christened by Rudolphi from specimens sent to him byBarnett, obtained from a young woman, is removed fromthe category of human entozoa, M. Vaillant believing it tobe a case of imposture. Speaking of the trichina, 1B’1. Lutonstates that, though the reporter of the French Commissionon this subject considers 750 Cent. as fatal to the worm, hehas reason to believe that it requires to be exposed to atemperature of 100° Cent. (212° Fahr.), and continued forsome time, in order to kill it.The article on the Shoulder, by M. Panas, is a very ela-

borate one, extending over nearly 100 pages, and includinga full account of the anatomy of the parts about the sca-pulo-humeral articulation, the physiology of its movements,and the pathology of the various luxations that may occurin this region, with the operations that have been proposedor performed. The luxations are divided into the anteriorand posterior. The former are subdivided into medio-,sub-, and supra-glenoid, and these again into extra-, sub-,and intra-coracoid and sub-clavicular for the medio-

glenoid, and scapular and costal for the sub-glenoid; andthe posterior luxations are divided into the sub-acromial and Iinfra-spinous. Most of these are illustrated by drawings, ’,,which, however, are somewhat below the average in point Iof execution. A sketch is given of the curious and ingeniousapparatus of Robert and Collin for effecting extension andcounter-extension-a very inefficient substitute, we shouldimagine, for the hands of a good surgeon, who understandswhat he wishes to effect. Some interesting observationsare appended in reference to obstetrical paralysis of theshoulder, due to pressure exerted by the forceps or to trac-tion by the fingers of the accoucheur upon the nerves ofthe brachial plexus, which we do not remember to have else-where seen noticed. The observations have been collected

by Duchenne, and are accompanied by several drawings.In the cases resulting from traction the same group of

muscles is always paralysed-namely, the deltoid, the infra-spinalis, the biceps, and the brachialis anticus. The cases,

I

if left alone, result in complete paralysis of the limb; butif treated early by electricity, readily and completelyrecover.

We have only space to notice M. Aug. Voisin’s articleon Epilepsy, which is very complete, the author beingwell known for his essays on the subject. The paper isillustrated by numerous sphygmographic tracings, sometaken at the very instant of the attack. He entertains no

doubt, from his own observations, of the hereditary natureof the disease; but differs from Esquirol and Trousseau inthinking that, putting alcoholism on one side, there is nopredominating influence exerted by the male. He mentionsthe curious fact that epileptics suffering from severe attacksexhale a large quantity of ammonia from the lungs. He

regards the medulla oblongata and the cerebellum, withthe connecting fasciculi of these two organs, as the partsprimarily at fault in this disease. Lastly, he speaks veryhighly of the bromide of potassium.On the whole, the volume is a worthy continuation of its

predecessors.

MR. RADCLIFFE’S REPORT ON THE SANITARYSTATE OF LEEDS.

THis report commences with an interesting history of thesteps taken to improve the town of Leeds. In 1868 a statis-tical committee was appointed to investigate the sanitarycondition and house accommodation of the town, and thesocial, industrial, moral, and educational state of the popu-lation. An abstract of this report is to be found in thefirst volume of the Statistical Society, and copies were sentto the mayors of all the principal towns in the kingdom,with a recommendation that a similar inquiry should beinstituted in each. A local Act, which encompassed whatwas desirable more than what was practicable, was obtainedin 1842, and under this Act more than a million of moneyhas been spent, without, unhappily, any serious reduction inthe amount of preventable disease. The report then goeson to describe the actual state of things. As to the town

proper, diarrhoea still prevails excessively among the popu-lation ; fever also is much in excess ; and there are no indi-cations of a diminution of the very high death-rate. Fromthe borough, exclusive of the town, true typhus is neverabsent. Mr. Radcliffe points out the great importance ofrecognising the localities in which epidemic disease chieflyprevails, and he finds that, notwithstanding the enormousincrease which the town of Leeds has undergone since 1832,and irrespective of its many internal changes, the localitiesin which cholera then prevailed were the principal seats offever in the years 1834-39, and of fever and cholera in1847-48 ; of fever throughout the years 1860-65, and in1867; and of diarrhoea and fever in 1870. The descriptionof these localities in 1832 is as true now as it was then ; thenotoriously unwholesome streets, lanes, alleys, and yards ofthat time are notoriously unwholesome now; and it iscurious to find that the localities in Leeds which havereceived the least advantage from the various costly sani-tary works carried out during the past twenty years are thevery seats of the persistently high mortality that gave riseto their execution.Mr. Radcliffe then proceeds to show that the high in-

fantile death-rate from diarrhoeal diseases does not arise from

maternal neglect, it being highest in that part of the townwhere the mothers are not taken away from home to work.Nor is it the result of a high birth-rate, which is proved tooccur as well with a low as with a high infantile mortalityand the converse. And he reaffirms the position which isgenerally received, that the population suffering from a

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high diarrhceal death-rate breathes or drinks a largeamount of putrefying animal refuse. Proceeding to details,Mr. Radcliffe, whilst noticing the great improvements whichhave been effected by the sanitary staff, gives an account ofa fever den, in which there is a middenstead twenty-onefeet long, five feet ten inches broad, and which is six feetbelow the level of the ground. Into this fell not long ago ahalf-tipsy man, plunging deep into the revolting filth, andthere, suffocated, he lay until, days afterwards, discoveredby the scavengers. Middensteads as large as dwellingrooms are numerous, whilst any of such a modest size as tocontain but a ton of filth are comparatively rare. Theseabominations are often built into, and form part of thehouses. In one court two-thirds of the whole space is occu-pied by privies and middensteads. No less than 829 privieswith middensteads attached exist below sleeping rooms andadjoining living rooms. Indeed, there appears to be anabsolute ignorance of the danger of accumulating quanti-ties of excremental matter in close proximity to inhabitedhouses, and an entire indifference to the requirements ofcommon decency. There are 11,500 middensteads, which,on an average, are emptied only four times each in the year.But the walls and floors are so fouled with soakage that thereceptacles are probably as dangerous after as before theemptying. These huge reservoirs of filth are beingdeliberately reproduced in the newer parts of the townunder the sanction of the corporation. The street sweep-ings are scavenged by a separate staff, and the greater partis taken to a dep6t placed in the very centre of the mostdensely populated part of the town. So noisome are theexhalations that the neighbours complain of their utterinability to ventilate their sleeping rooms during the day-time. The rest of the sweepings are used, as they are inLiverpool, for filling in the foundations of houses. Thedistrict medical officers state that several streets, notoriousfor unhealthiness, have been built upon deposits formed ofstreet sweepings and offensive refuse. In fact, part of thesweepings are disposed of for manure, and part for fillingin. Mr. Radcliffe properly says that the use of street

sweepings and of other refuse rich in organic matter for theformation of house foundations altogether sets aside one ofthe most important and best understood requirements ofa healthy dwelling house-viz., an unpolluted- site.The sewers of Leeds have been constructed upon a com-

prehensive scale, at a cost of .8225,000. They serve five-sixths of the whole population, and carry into the riverAire 12,000,000 gallons of sewage daily. There are, how-ever, localities in Leeds which have not been sewered at all,or, if sewered, no proper record has been kept of their con-struction and whereabouts. These localities are, withoutexception, the fever and cholera nests of the town. Insteadof the sewerage being methodically extended from themost unhealthy to the less unhealthy districts, the processhas been inverted, and there are courts and alleys leadingout of the principal streets of the town which are eitherwithout sewers or have sewers improperly constructed ornot communicating with the main sewer of the street orboth. The contents of the sewers are rendered unusuallydangerous by the quantity of excremental matter whichsluggishly flows into them from the middensteads withouta sufficient quantity of water; whilst until 1869 no meanswhatever were taken to prevent the diffusion of sewer gasesin the interior of houses, the only outlets for these gasesbeing a few rain-pipes which opened into the sewers andcasually dry or untrapped gulleys. Even the ordinary safe-guard of " traps " to the house drains had been very largelyomitted, and the first entry of such work having been doneoccurs in the reports of the Sewer Committee last year.The sewerage of Leeds, while it has largely promoted sur-

face cleanliness, has not materially diminished the excre-

ment nuisance which has long been the cardinal evil in thetown; indeed, in respect to the drainage of middensteads,it has aggravated the evil; and it is on this account thatthere have been no returns in health and in saving of lifeproportionate to the expenditure-in fact, no return at all.The state of the river Aire is, as may be imagined, execrable,and the town is now under injunction not to pollute it as

they do. The water-supply is about twenty-three gallonsdaily per head. It is obtained from the Wharfp, whichreceives the sewage of the town of Otley, and the refuse ofseveral worsted and paper mills, tanneries, &c.; but a freshand probably purer source has lately been secured, and

the necessary works are being constructed by which aportion of pure water is already brought into use.There appears to be a singular ignorance of sanitary

principles in Leeds. The sewers are foul for want of

flushing, and even for waterclosets there is an unwise

economy in the supply of water. Mr. Radcliffe shows thatwith proper care the present- supply to the town ought toba sufficient for flushing, and for the adequate removal ofall excrement. At the same time he does not insist uponthe exclusive reliance on water carriage, but lays it downas otherwise imperative upon the authorities to institute asystem of excrement removal sufficiently prompt and certainto obviate the abominable nuisances which now prevail.Mr. Radcliffe gives the medical officer of health and his

sanitary staff the fullest credit for their exertions, but heremarks that at best they cannot do more than interposean obstacle to the further growth of disease in Leeds untilthe prime sources of disease described in the report havebeen removed.

DR. GUY’S LECTURES ON WAR IN ITSSANITARY ASPECTS.

ON June 7th Dr. Guy commenced his lectures on this

subject, having especial reference to the period between1793 and 1815. They would constitute, he said, a continua-tion of the lectures he delivered last year at King’s College,in which he brought the sanitary history of England downto the commencement of this period. After a brief accountof the general characters of the war which followed, he ob-served that the twenty-two years of uninterrupted warfarestrained to the utmost the resources of England in menand money. Nearly 300,000 men were continually with-drawn from the productive ranks of life, and in every yearof warfare 8000 perished in excess of those who would havedied had peace prevailed. In considering the sanitarylessons of this war, he proposed first to regard it in thelight afforded by the experience of peace ; then, takingas standards of comparison the numbers of killed andwounded, to compare with these the deaths occasioned bydisease, distinguishing from one another those occurring inmilitary and naval operations ; and, lastly, to inquirewhat science and art had done to save the lives of fightingmen.

The first question to be considered, then, was, what lessonsapplicable to war does the experience of peace supply ?Are there any results of health impaired and life sacrificedin times of peace which admit of application to times ofwar? 2 War, whether on land or sea, is, in its essentialnature, the bringing of one armed crowd into violent col-lision with another. The conditions of naval and militaryfighting men vary much, but in each the evils of over-

crowding are liable to occur. Even in peace this may bethe case. Not many years ago the mortality in the FootGuards, mainly from this cause, was nearly twice as greatas among the city police. In war the danger is enormouslyincreased. Every foreign war means the transport ofcrowded men, ill disciplined, under circumstances unfavour-able to health, to foreign lands, there to be exposed, alwaysas a crowd, to fatigues, privations, bad hygienic conditions,and to fighting as a rare diversion.The experience of peace supplies, unfortunately, abund-

ant examples of life cut short by overcrowding. Such cases

may be arranged in three categories: one where, as inworkrooms, dormitories, &c., individuals are exposed tono other unwholesome influences than those emanatingfrom their own bodies, or to these in conjunction withheat, dust, and the effiuvia of certain manufactures;secondly, those in which the noxious effiuvia of damp soiland defective drainage are superadded; and, lastly, over-crowding in hospitals, by which many contagious diseasesare produced or spread. The lecturer then described atlength some examples of overcrowding, beginning with theextreme form of forcing many persons into a narrow space.Such was the well-known case of the Black Hole at Cal-cutta. Overcrowding carried to this point of suffocation is,he said, rare even in war. Overcrowding carried to suchan extent that the space for each person does not muchexceed that required for the recumbent posture, is much