23

scope, from the blood after incision. None were found inthe serum from the vesicles.

Varicella, Gangrenosa.-Mr. STANIFORTH read the notesof this case, which occurred in a boy aged seventeen months.The vesicular eruption was preceded by about twelve hoursby a scarlatina-like rash, and the patient’s mother statedthat the whole family had suffered from " scarlet fever andmeasles four months previously, which Mr. Staniforththought indicated a family tendency to a scarlet rash as apreliminary to an exanthematous eruption. On the sixthday of the disease most of the vesicles had dried up intohard black scabs surrounded by erysipelatous-looking areas,varying in size from a sixpence to a florin. By the tenthday the whole of the vesicles except those on the head andface had become converted into deep circular ulcers, whichhad a clean, punched-out appearance, and extended downto and exposed the fascia. In the centre of several wereashen-grey sloughs. Three weeks and a half after thecommencement of the attack the ulcers began to heal.During the attack the child was very restless, the pulserapid and feeble, and the temperature at first high, butsubsequently about 100° F. There was no family history ofsyphilis or tuberculosis. The patient had had vaccinia andmeasles, and had been suckled at the breast. Anothermember of the family began with varicella exactly fifteendays after the appearance of the rash in the former case, butrecovered in ten days without any complications.The Proposed Watereloset System for- Sheffield.-Dr.

CLEAVER read a paper on this subject, in which he gave anaccount of the trough closet system, with its disadvantagesand dangers in comparison with the separate waterclosetscheme on the old plan. He next went into considerabledetail concerning the Sheffield water-supply, showing thatthe surplus of four million gallons per diem was at thepresent time being consumed at the rate of half a millionin two years ; so that at the present rate of increase of thetown and suburbs the water-supply would only last aboutten or twelve years at the most. Attention was drawn toother systems of dealing with excreta, such as greater careand supervision over ashpits and burning the refuse,destructor furnaces, with combustion chambers, &c., andit was argued that it would be better to carefully considersuch means of dealing with refuse before endangering thewater-supply of the town.-In the discussion whichfollowed Dr. Hunt, Mr. Arthur Jackson, Mr. Makeig Jones,Dr. Gwynne, Dr. Sinclair White, and Mr. Pye-Smith tookpart.Lead Poisoning.-Dr. SINCLAIR WHITE showed a case of

Lead Poisoning in a girl eight years old. The case had beenunder treatment for several months, and was slowly im-proving. There was paresis of the extensor muscles of thehands and of the flexors of the feet. The latter, owing topointing of the toes, compelled the patient to lift the feethigh off the ground, and produced a remarkable gait. The"blue line was faintly discernible. The girl drankRedmines water, which contained from 0’30 to 0’45 of agrain of lead per gallon. Her mother, who is a patient ofDr. Sidney Roberts, and is suffering from severe leadpoisoning attributable to the same cause, was likewise ex-hibited to the Society.Poisoning by Coal-gas.-Mr. MAKEIG JONES read short

notes of a case in which ordinary coal-gas had escaped froma leaky main into an old drain, and thence through a con-nected sink-pipe into a house, severely poisoning two boyssleeping in the room above the sink. A candle was lit inthe room, but no explosion took place, showing that therewas less than 10 per cent. of gas present.Specimens.-Dr. HARGREAVES exhibited several morbid

specimens. One was a Stomach showing a mass of Scirrhusabout the middle of the lesser curvature, and portion of theliver showing secondary deposit. The patient, a womanaged thirty-five, had suffered for four months from dyspepsia,vomiting, but no haematemesis, and latterly she had becomejaundiced. Cancer was diagnosed from the cachexia and ahardness felt at the margin of the liver. There were alsosome enlarged cervical glands. Dr. Hargreaves also showeda Mammary Tumour and two Glands from the Axilla. Thetumour was situated in the left breast, and its origin wasattributed to a blow received eighteen months before. Sixyears previously the patient had a tumour removed fromthe right breast, about the size of a walnut, which had alsobeen attributed to the effects of a blow. There had beenno recurrence in the right breast.

Reviews and Notices of Books.A Treatise on Gout. By Sir DYCE DUCKWORTH, M.D.Edin.

Pp. 476. London: Charles Griffin & Co. 1889.

THIS treatise is in many ways an important publication.It has been gradually forming shape in the author’s mindfor a number of years, and it presents opinions which aretherefore matured and perhaps unchangeable. The delayof publication, however, while it lends the chief interestto the treatise, is also responsible for slight demerits.Materials have accumulated to such an extent that afuture edition would gain by judicious pruning; opinionswhich are evidently deeply rooted are reiterated in almostidentical terms. These naturally form blemishes upon amost interesting subject otherwise very ably treated.The standpoint assumed from the outset is essentially

that of a physician who has to study and treat all forms ofdisease; hence the author disclaims the title of a specialist,whom he defines as one whose thoughts and practice mustnecessarily be narrowed and warped by devotion to any onesubject. The chief fact upon which insistence is made is theauthor’s belief in the existence of "distinct diathetic habits of

body." In any book upon a single disease, however proteanits manifestations, there is very little scope for originalityin the method of arranging the materials. Points of

individuality are to be sought rather in the amount ofattention devoted to the separate sections into which thesubject naturally divides itself. Judged from this standard,the relation of gout to other morbid states, and the

"medicinal, regiminal, and preventive" treatment of theseveral varieties of gout appear to be the sections whichpossess the greatest interest to the author, and they arealso those upon which he speaks with the highest authority.Bearing in mind the leaning of the author to the views of

the French school rather than the German, the criticism ofthe pathological doctrines concerning gout will be found ofdeep interest. There can be little doubt that Garrodassumed too much in attributing defective elimination ofuric acid to temporary failure on the part of the kidneys,although Gairdner’s view of an arrest of renal function re-sulting from great emotion or nervous influence appeared toadopt this opinion and to offer an explanation, and it has,indeed, been largely accepted as a working hypothesis.That there may be other sides to the picture is evi-denced by the hepatic theory of Murchison, the chemicaltheories of Ralfe and Latham, the arthritic diathesis of

Hutchinson, and the degenerative and necrotic theories ofOrd and Ebstein. These conflicting doctrines are wellsummarised as a prelude to the author’s views of the

pathogeny of the disease, which resolve themselves mainlyinto a conviction of a distinct diathesis in which hereditynecessarily plays an important part. In 1880 Sir DyceDuckworth put forward a plea for the neurotic theoryof gout, and although he is now disposed to be less

dogmatic and precise in localising the supposed lesionin some part of the medulla oblongata, he still clingsto the notion that gout owns a nervous as well as a humoralpathogeny, and he expends much ingenuity in support ofthis opinion. All the known facts of gout are carefully passedunder review and made to support the position of gout as aneuro-humoral disorder. Incidentally it may be mentionedthat very little regard seems to be paid (p. 22) to the

memory of the ancestors of the gouty individual, and theitalicised list of enormities in the parent which may be de-

veloped into gouty manifestations in the offspring is sufficientto destroy much innocent, kindly veneration. In pursuing theargument from the therapeutical side, and endeavouring toshow that the drugs with most influence upon gout affectthe nervous system, a curious error occurs implying that

24

the intestine is supplied by the vagus. Still, upon thewhole, it may be said that Sir Dyce Duckworth fairly stateshis case, even though he is compelled to assume a "failureof full physiological activity in the tissues, leading to im-perfect elaboration of the food taken," and, in the end,to widen the definition of gout so as to remove the old I’and-mark of " uratic deposit as the absolute touchstone in theexact diagnosis." At the close of this very important chapteroccurs a footnote that will cause some surprise, since it ex-presses the author’s conviction that no very great advancehas been made upon the views held and taught by manywriters of the " last two centuries," and the authority ofSydenham is finally claimed in support of a " neuro-humoralpathogeny for gout." " ,

., The fourth chapter is devoted to the morbid anatomy ofgout, and here the way is more clear, although there is ahint at the outset that this disease is to be sought by thephysician during life rather than by the morbid anatomistafter death. Still, a summary is presented of much of therecent work, ample justice being done to the observations ofHutchinson, Charcot, Norman. Moore, Wynne, and others.Next in importance comes the chapter upon the relation ofgout to other morbid states. The difficulties experiencedw differentiating chronic forms of gouty and rheumaticarthritis are sufficiently dealt with ; the author believesthat each " breeds true," but that comminglings sometimesoccur. Here he joins issue with Hutchinson, who holdsthat all that is not plainly gouty is rheumatic, and hedevotes much labour to controvert this view-labour whichis necessitated not so much by the importance of the theoryas by the eminence of the author propounding it. Upons,urgeons who refused credence to Charcot’s views somesevere strictures are passed, and then, in epigram, theauthor’s idea of the position of rheumatic arthritis is thusexpressed : " It seems only too likely that in England thecoalescence of rheumatic and gouty diseases has produced amongrel type of malady in many instances-not a meremixture, but a new type which may propagate itself, andthat thus may arise some of our perplexities. Such propa-gation is not likely to be enduring. If hybrids do not breed,mongrels certainly may." The determining influence ofbeer drinking and lead poisoning receives due attention; but,with regard to the latter, it would seem from the evidence tobe more probable that gout furnishes a special susceptibilityto the influence of lead than that lead workers suffer speciallyfrom gout; even upon this point, however, there is much roomfor difference of opinion, and Sir Dyce Duckworth impartiallyputs forth the evidence upon both sides of the question.Space fails us to adequately present the views expressedupon the relation of gout to diabetes and glycosuria, or tothe numerous other conditions so frequently associated withit. Nor can we, follow step by step the elaborate chaptersupon -the clinical varieties of gout and the affections ofspecial organs and textures. In these Sir Dyce Duckworthhas set forth the results of considerable personal experience,and he has not hesitated to incorporate much of the

experience of . others. More space than usual is de-voted to, ,the treatment of the several varieties of gout.TJw terminology (ether, potass, pediluvium, &c.) appears

designed to show the author’s staunch adherence to theremedies of a past age, and contrasts curiously with hisrecommendation of antipyrin, antifebrin, paraldehyde,strophanthus, bromide of caffeine, lithium guaiacate, andother unorthodox remedies. This is a most valuable

section, and probably, reference will frequently be made to itin the doubts and difficuities inseparable from the treatmentoff gout. Chapters upon drinks and dietary, upon waterdrinking,, baths, and climatic resorts, upon life assuranceand ,prognosis in relation to gout, satisfactorily bring thebook to a close.. p ., _ ,,; , , - .

_ , , . _ . .

, . , , , .

Reviewing the treatise as a whole, if it be conceded thatSir Dyce Duckworth has made a most laborious and usefulcollection of most of the views that have ever been

expressed upon this classical subject, it must also beadmitted that he has scarcely submitted them to sufficientcompression. In his painstaking anxiety to do full honourto previous writers he has somewhat lost sight of the

importance of doing justice to himself and to his readers.Still, as it stands, this book is a very valuable storehouse ofmaterial on the nature, varieties, and treatment of gout.

Cyclopædia of the Diseases of Children, Medieal and Sur-gical. Edited by JOHN M. KEATING, M.D. Vols. I.and II. Philadelphia : J. B. Lippincott and Co.

_ Edinburgh and London : Young J. Pentland. 1889.

THE literature of diseases. of childhood is of essentiallymodern growth, and there is perhaps hardly any other fieldof study in the whole range of medicine which has yieldedso much valuable material to the pathologist and thera-peutist alike. On the importance of this branch of study itis needless to dwell ; for it is self-evident, and it is creditableto our country that here were seen some of the first systema-tised attempts to pursue it. But hitherto the most volu-minous treatises upon it have proceeded from other lands.Amongst them the first place should be assigned to theclassical work of MM. Rilliet. and Barthez, of which thefirst edition appeared in 1843, whilst a generation laterwas issued the compendious Handbuch, edited by Gerhardt(1877). Nor need we speak of the numerous manuals andmore ambitious works from that of C. West onwards, whichhave done so much to promote an intelligent interest inthis fascinating and important subject. The volumes beforeus represent the high-water mark to which this literaturehas attained ; they form part of a work of abiding value,which represents the combined experience and learning of

, English and American authorities.! Dr. Keating is to be congratulated upon the success

attending his efforts, and the number and variety of excel-lent writers that he has enrolled. Dr. A. Jacobi contributes

, the Introduction, in which he truly points out how limited, have been the efforts hitherto made to impart instruction, in children’s diseases, although there are not wanting signs. of the establishment at no distant day in all medicalr schools of a clinique of " pædiatrics." Various topicsr are discussed preliminary to the main object of theL work. Thus, Dr. McClellan writes upon the Anatomy

of Children, a subject too much neglected, but of prime. importance. Even more disregarded ’is’ the’ subject ofL the Physiology of Infancy, upon which Dr. Angel Money) writes, and, considering the scantiness of observed facts ini this department, he has well succeeded in directing atten-

tion to many interesting topics. A chapter on Diagnosis byf Dr. James Finlayson should be widely read. It is full ofi shrewd advice and practical hints. Would that all prac-, titioners would take to heart the importance of his protests against laxity in diagnosis. We commend to notice also- his ridicule of the "fetish" " of "teething," so often in-. voked as a cloak for ignorance. His article traverses thes whole field of the bedside examination of the case, and is3 certainly most valuable. There is also an article upons the Influence of Race and Nationality in Disease, by, Dr. J. W. Byers, and even the more widely applicable1 subject of bacteriology is introduced in the Outlinese. of Practical Bacteriology contributed by the ’competentt pen of Dr. E. 0. Shakespeare. More directly cognatet to the subject matter of the Cyclopædia are the articlesr on Maternal Impressions, by Dr. W. C. Dabney-ane

interesting contribution to a singular subject, illustrated by

e elaborate tables ; those on Diseases of the Foetus, on JoinedTwins, Embryology, Injuries of the New-born, &e. Of

25

special importance are the articles on Diet and Nursing,to which considerable (but not undue) space is allotted.Dr. Rotch’s article on Infant Feeding is remarkable for itsscientific tone and the analysis of milk which it contains,besides the practical demonstration of the inadequacy ofso-called "infant foods." Dr. Parish deals with the

subject of Wet Nurses, and Dr. Adams with that of Dietafter Weaning. The services of Miss Catherine Wood havebeen secured for the article on Nursing of Sick Children, inwhich her long experience at the Great Ormond-street

Hospital adds much to the value of her instructions.

Nursing Hygiene is treated by Dr. Yale, and Dentition byDr. J. Dunning, whilst the interesting subject of Pubertyis treated in an important article by Dr. T. More Madden.Part II. opens with an article on Fever by Dr. W. Pasteur,

wherein the writer inclines to the nervous theory of fever asseeming " to offer the best working hypothesis yet advancedto explain the various phenomena of the disorder." Hediscusses the subject with much lucidity, and his articleincludes a sketch of the symptomatology and generaltreatment of the febrile state. Enteric or Typhoid Feveris contributed by Dr. J. C. Wilson, who begins by a briefsurvey of the history and etiology of the disease, adoptingthe causal importance of Eberth’s bacillus, and who

points out the differences in course and symptoms ofthis fever in the child and in the adult. The articleis a most able one, and should be very helpful to

the practising physician. Dr. Alex. Collie contributesa brief account of Typhus Fever, and Dr. Curtin one ofRelapsing Fever. Cerebro-spinal Fever is most thoroughlytreated by Dr. J. Lewis Smith, largely based on hisown experience of the epidemic of 1872 and cases seen sincethen. The same writer contributes the article upon themore familiar but no less fatal affection, Diphtheria. Adopt-ing practically the views advanced by Oertel and others asto the local commencement of this -disorder with secondarybut rapid systemic infection, he yet thinks there are casesin which systemic poisoning seems to be the first indicationof the disease. The account given of diphtherial paralysisis very full and exact; indeed the whole article is, as

might be expected, fully up to date, and although inthe all-important subject of treatment the various recom-wendations of many authorities are considered, the sharetaken in the modern conception of the nature of diphtheriaas a guide to rational treatment is clearly shown. ScarletFever is contributed by Dr. Busey, Measles by Dr.

Waxham, and Pertussis by Dr. Dolan, who obtained theMedical Society’s Fothergillian Medal for his essay on thissubject. In his article Rubella (Rothein), Dr. W. A. Edwardsmaintains staunchly the specificity of the disease, and

gives in tabular form the differential diagnosis from scarletfever and measles. Variola is treated by Dr. Blackader,and Vaccination by Dr. W. T. Plant in a carefully syste-matised article, which, however, would have been rendered

more complete by a fuller discussion of the alleged injuriousresults of this inestimable practice. Of other articles inthe first volume may be mentioned : Erysipelas, by DrHirschfelder ; Rheumatism, by Dr. Cheadle, in which thefull significance of the "rheumatic nodules" is admirablydemonstrated ; Malaria, by Dr. Forchbeimer; and YellowFever by Dr. Guiteras.The first part of the second volume consists of articlesdevoted to Diseases of the Skin, contributed by Drs. NevinsHyde, Hardaway, Bulkley, Harlingen, Stel wagon, and others.Then come a series of articles upon Constitutional Diseasesand Diseases of Nutrition, which for general excellence andthoroughness are hardly to be equalled. They form adistinct contribution to literature, and are written in fullknowledge of the latest teachings of science. Thus, Dr.Ashby, who deals with the somewhat difficult subject

of Scrofulosis, dwells upon its relationship to tuber-

culosis, and clearly conveys the impression that the formerchanges may originate as simple inflammatory reaction tosimple irritation, and in later development become the seatof tubercular processes. Dr. Jacobi gives a clear expositionof the nature of Tuberculosis as well-nigh universallyaccepted. He admits the liability to the communicationof the disease through the medium of milk from tuber-culous cows. In his deprecation of bacillicidal remedies hewill carry with him general concurrence, and also in hisadvice to use every means to sustain the organism in itsresistance to the bacillary invasion. Syphilis is dealtwith by Dr. Abner Post, who gives a full descrip-tion of the lesions met with in hereditary syphilis andan equally detailed account of the symptomatology.The next article, Rachitis, by Drs. Thomas Barlow andJudson Bury, is one of the most striking in the work. In

particular may be specified the care and minuteness withwhich the skeletal changes are studied. The pathologicaland etiological data are preceded by the clinical picture ofthe affection, whilst the summary of the former leads tothe conclusions that proliferation of cartilage at the junc-tion and with increased vascularisation is pathognomonic,softening of bone being more variable ; that such

changes are not to be distinguished from inflamma-tion ; and that the best description of the pathologicalside of the subject is that which consists "in an

irritative overgrowth of the osteogenetic tissues, andthat this, and not deprivation of lime, is the primaryfact in the disease. Most valuable, too, are the re-

marks upon treatment. Dr. Barlow also contributes thearticle on Scurvy, in which he shows, by means of illustra-tive cases, the leading features of the disease in childhoodand infancy as compared with the adult type. Dr. Judson

Bury writes on Cretinism-a clear and ably composed article.A melancholy interest attaches to the next article, thaton the Urinary Diatheses, Oxaluria, Phosphaturia, andLithuria, from the pen of the late Dr. Milner Fothergill.His remarks are chiefly confined to lithuria, and are writtenwith the characteristic freedom of the author. A brief

paper on Diabetes, by Dr. G. B. Fowler, closes this section.A large number of topics are dealt with in the next part,which includes diseases of the Nose, Pharynx, and Tonsils,the latter, by Dr. Beverly Robinson, being notable for thedistinction he makes in the forms of tonsillitis ; diseasesof the Larynx, including a contribution from Sir MorellMackenzie upon New Growths in the Larynx. The

subjects of Intubation and Tracheotomy are dealt withrespectively by Dr. Westrup and Dr. Wharton-both admir-able in their way. Of the articles dealing with Diseases ofthe Lungs we would invite especial attention to Dr. Ninot’supon Croupous Pneumonia, in which he proves how far morefrequent this disease is in childhood than is mostly admitted;that on Broncho-pneumonia, by Dr. Gordon Morrill; onPhthisis, by Dr. Jacobi; and Pleurisy, by Drs. Whittierand Vickery. We would fain dwell on these and manyother of the excellent monographs in which this volume

abounds, but must hasten to bring this notice to a close.But we cannot do this without also noting amongst thearticles upon diseases of the heart, the valuable contribu-tions on Endocarditis, by Dr. Cheadle ; Enlargement of theHeart, by Dr. Mitchell Bruce; and on Valvular Disease, byDr. Sansom. Dr. Allchin’s elaborate analysis of Diseases ofthe Mouth is almost the first attempt to reduce to systematicorder a range of affections too much neglected in practice.The volume closes with the discussion of the subjects ofHare-lip and Cleft Palate, by Dr. Ford Thompson, one ofseveral papers of surgical interest contained in the work.

Cursory as this notice has been, we trust neverthelessthat enough has been said to indicate the scope of this

26

Cyclopaedia and the impression we have gained of the highposition to be assigned to it in medical literature. It is atruism to say that all works of this kind must be unequalin merit; but no impartial reader:can fail to observe howgreat has been the care to assign to those best fitted for thetask the special subjects on which they treat. The resultis a collection of monographs which as a whole will bearcomparison with any similar publications, and which willdemonstrate the advance of medical science and the sharetaken in that advance by America and England. Thework is produced in excellent style both as to paper andprinting, is well illustrated, and is further provided with acopious index to each volume.

The Student’s Surgery: a Multum in Parvo. By FREDE-RICK JAMES GANT, F.R.C.S., Senior Surgeon to theRoyal Free Hospital. London: Bailliere, Tindall, and Cox.FOR a long time there has been a want felt and expressed

amongst students reading for their final examinations forworks on the subjects required, of less extended proportionsthan those which characterise the text-books ordinarily inuse. The number of subjects in which the student is

required to show his efficiency, and still more the widerextent of ground now covered by each, make economy of timein getting them up of considerable importance; a perusalof the larger works is postponed to the future, and meanwhilethe book which will put the subject in the most concisemanner is sought and read. Much is to be said from thestudent’s view of the question, though we do not think thatthe standard of our future practitioners is likely to beimproved. The demand has met with a supply, and duringthe last year or two small volumes on medicine, surgery,pathology, &c., have issued from the press, many of them

answering the purpose for which they were written, otherscuriously inadequate. Amongst the former we must placethe " Student’s Surgery," written by the veteran pen of Mr.Gant. For several years the profession has been acquaintedwith his larger work on the " Science and Practice of Sur-gery," which met with a good reception both in this countryand in America, and has reached the third edition.The present work is written with the view of putting

before students the essentials which are requisite for theiradequate preparation for the ordinary Final Examinationin Surgery, including Pathology. The book is essentiallyan epitome of the large work to which we have justreferred, without the chapters relating to the eye, ear,

teeth, skin, female genital organs, and orthopaedics, as

contributed by selected writers in that work, but it presentsthe same order of arrangement. The omission of these

special sections gives more space for the consideration oftopics of general surgical importance, and the volume hasincluded within its covers more than 800 well-printedpages. A table of contents precedes the work, and it isnecessary to refer to this in order to find the different

subjects which are taught in its pages, as there is no index.The illustrations, which number 159, are selected from the

larger work. Altogether the book, which is of an ex-

ceptionally presentable appearance, and one upon whichthe publishers may be congratulated, well fulfils the objectfor which it is written. The information is conveyedin a manner likely to ensure success, the style of treat-

ment of the subject not being that of a " cram" book,though from its small size the discussion of the moretheoretical parts is not entered upon.

Electricity in the Treatment of Uterine Tumours. ByTHOMAS KEITH, M.D., and SKENE KEITH. Edinburgh:Oliver and Boyd. 1889.

A WORK on this subject from the pen of the most successfulof all operators on uterine fibroids must command general

attention. The book is dedicated to Dr. Apostoli, with pro-found expressions of respect, with the declaration that Dr.Keith has ceased for two years to perform hysterectomy foruterine fibroids, on the ground that the mortality " is outof all proportion to the natural history mortality of uterinetumours," with regrets for the "unfair treatment you havereceived in this country," and with a prophecy of the finaltriumph of Dr. Apostoli. The work consists of 106 cases,related apparently as the notes were taken, and with fewcomments. There is no tabular statement nor any

attempt at summarising. There is no index, and the readerhas to draw his own conclusions. This is not altogether tobe deprecated; but the conclusions resulting from the

perusal of the cases do not seem to us so obvious as theyappear to be to Dr. Keith. The relation of the cases

is not marked by the exact scientific accuracy whichwe should have expected from Dr. Keith, which atonce deprives us of the means of accurately estimatingmany of the cases, and we have to content ourselveswith somewhat general statements. One fact particu-larly strikes us, and that is the advanced age of the

patients, the great majority of whom appear to havebeen over forty. Another fact is that several of the

patients are reported to have died. A large number appearto be grateful, some on grounds which are not plain to us.In the preface Dr. Keith compares electrical treatment withhysterectomy, to the great disadvantage of the latter. Hedoes not, however, compare it with sound medical and

hygienic treatment. If this has been tried details shouldhave begun the history of each case, but we cannot takeit for granted. In the dedication Dr. Keith alludesto a very pregnant subject-the "natural history" offibroids-a chapter yet unwritten. We know, however,that their natural history is peculiar, and that they areliable to very sudden alterations, especially between theages of forty and fifty-the age of the large majority of Dr.Keith’s patients. How much of the "results" of electricaltreatment must be laid to the account of the " natural his-

tory" of fibroids ? How many equally satisfactory seriesmight be produced under general medical and hygienic treat-ment, or under no treatment at all ? The answer is not for usto give, but it should be considered. The time has not yetarrived fora final answer, but it must not be forgotten that Dr.Apostoli’s treatment is reported to be declining in America,which cannot, like England, be held up as the home ofconservatism and prejudice. We think even England hashardly deserved the character given it by Dr. Keith in hisdedication, unless he ignores the innumerable writers whowere suddenly converted by the treatment and speaks onlyof the few cautious writers and teachers who have main-tained a mildly judicial frame of mind. We can only addthat our motto still is " respice finem."

OUR LIBRARY TABLE.

Clinical Lectures on the Diseases of Women. By J.MATTHEWS DUNCAN, M.D., F.R.S. Fourth Edition.J. & A. Churchill. 1889.-The fourth edition contains fivenew lectures on " Myxoma of the Chorionic Villi," " Extra-uterine Gestation," "Sterility," "Dermoid Cysts," and"Hysteria, Neurasthenia, and Anorexia Nervosa." Ofthese it is sufficient to say that they are worthy of theauthor. Of the lectures we have so often spoken that weonly now repeat that they are, in our opinion, unique, asgood, fresh, wholesome food for the minds of students andpractitioners. The directness of the language does notpreserve them from being somewhat hard of assimilation,as must be the case where so much knowledge is concen-trated into so small a compass.The Psychological Factor in Selecting a Climate for

Invalids. By EDWARD 0. OTIS, M.D. Boston.-In this