1297ROYAL ACADEMY OF MEDICINE IN IRELAND.

died. At 20 years of age and upwards there were eightdeaths. Of these nine deceased cases seven were strong,well-developed men and five were distinctly alcoholic.As regards differential diagnosis from typhoid feverEhrlich’s diazo test was useless but Widal’s reaction wasthe best method to use when in doubt. Strong beef-tea and meat juices were used partly to replace alcoholicstimulants. The staple diet was milk supplemented insome cases by Benger’s food. Cold water was given freely,also white fish, bréad and milk, and eggs were allowed sosoon as the temperature became normal. In about three-quarters of the adult cases and one-quarter of the childrenalcohol was required in doses of about half an ounce everytwo or three hours to each adult. Cardiac tonics werenot found to be of much service. Hypnotics were

required by about half the adults. Their early and free usewas found to be very beneficial ; sulphonal and paraldehydewere those most frequently employed. No antipyretic drugswere administered. Even in cases where the temperatureremained at 105° F. only frequent tepid sponging was

employed. Each patient was only allowed one sheet andone blanket as long as his temperature remained high.Besides this any patient who passed his evacuationsinvoluntarily was kept naked in bed in order tosave exhaustion caused by changing the nightgown.The ward temperature was usually not above 55° during theday and 50° during the night. When a patient developedthe crisis extra blankets were added to the bed and as soonas possible he was removed to a convalescent ward kept atan ordinary temperature. In all 16 nurses and four medicalmen had charge of the cases and none of these caught theinfection. This immunity might have been in part due tofrequent baths and plenty of open-air exercise. Another pre-caution might have contributed to the health of the staff-that was the sponging twice daily of the whole body of eachpatient with Jeyes’ fluid diluted with water. The patients’months were also carefully attended to, swabs of listerineand of an ointment of boric acid and menthol being usedevery few hours. In conclusion Dr. Ker said that this out-break was at least of average severity and that there hadbeen no change of type since the days when the fever usedto infest the city.-Dr. JAMES CARMICHAEL said that whenhe was resident in the Royal Infirmary in 1865 there were311 cases treated in the wards in 15 months and the mor-

tality was then 12 per cent. At that time a large proportionof students and residents (including Dr. Carmichael himself)took the disease.-Sir JOHN BATTY TUKE, Dr. AFFLECK,Dr. JAMES, Dr. ARGYLL ROBERTSON, and Dr. CHURCH alsojoined in the discussion. I

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF OBSTETRICS.

The Samaritan Hospital for Women, Belfast.-UterineCancer.

A MEETING of this section was held on April 21st, Dr.F. W. KIDD, the President, being in the chair.

Dr. JOHN CAMPBELL read a paper entitled " Two Years’Work at the Samaritan Hospital for Women, Belfast." This

hospital was founded in 1872 by the late Dr. W. K. M’Mordieand the present building was erected in 1874 through the munificence of the late Mr. Edward Benn. In 1898 Mr.Forster Green generously added two cancer wards. The

hospital contained 30 beds. Each patient brought a printedform signed by her medical attendant recommending her "asa fit person to receive gratuitous advice and treatment." Thissystem worked well and threw the responsibility of connivingat hospital abuse on the members of the local medical pro-fession. Patients to be operated on were well scrubbed withsoap-and-water and wore boric compresses over the seat ofoperation for three or four days beforehand. The day beforeoperation the region was well washed with soap-and-water,rubbed with turpentine, again washed with soap-and-water,and finally washed with one in 1000 sublimate solution andcovered by a compress wrung out of the same. This pre-paration was repeated on the morning of the operation day.The operator’s hands were cleansed by thorough washing,followed by washing in turpentine and again in soap-and-water. They were then put through the permanganate andsublimate processes in succession. Indiarubber gloves were

used if a septic case had been recently handled. The gloveswere boiled. Chloroform was given by Junker’s inhaler.

Flushing the abdomen was done in tuberculous peritonitisand in cases in which glairy fluid had escaped intothe abdomen. Drainage was used after flushing incases where much peritoneal fluid had been presentand in cases in which pus had escaped. The currentof opinion had now set in too strongly against drainage.A glass tube with a gauze wick was to be preferredand the bed-head should be raised. Sterilised gauzewas the dressing used for most cases. Iodoform was

used for wounds which were drained. During 1897-98 therewere 44 intraperitoneal operations performed in the hospitalby Dr. Campbell with a mortality of 42 per cent. Before

dangerous operations the patient and a near relativesigned a printed form authorising Dr. Campbell "to per-form whatever operation he may think necessary."-The PRESIDENT expressed his approval of these printedforms. He thought that gloves should be used in operationsonly when it was suspected that the hands could not berendered completely aseptic. He did not agree with Dr.

Campbell’s opinion that all the dangers of chloroform weredue to maladministration. When chloroform was adminis-tered guttatim he had seen no ill effects. Dr. Campbell’smortality of 4’5 per cent. was very satisfactory.-Dr. SMITHsaid that he had practically given up drainage. He believedthat after a few hours no drainage took place, sincea layer of protective lymph was thrown out roundthe tube which acted as a foreign body.-Mr. McARDLEsaid that he did not believe there was any needfor the printed form to be signed by patients about to

undergo operation.-Dr. MACAN agreed with Mr. McArdle’sremark about the printed form.-Dr. PUREFOY said he wasone of those who practised drainage but he never used arigid tube.

Dr. MORE MADDEN read a paper on Uterine Cancer andits Treatment, in which he laid stress on the early recognitionof this disease by local investigation as well as by micro-scopic examination of specimens removed by curetting inevery instance of possibly adenomatous or cancerous disease,of the uterus. He believed that that disease was primarilydeveloped in the cervix in the vast majority of instances.Moreover, he held that it frequently remained localised there-for a sufficient period to permit its complete and effectualcure by the timely amputation of the cervix, which, followedby the application of the actual cautery to the wound soproduced, he regarded as the best method of treatment.In 31 instances in which the cervix was thus amputatedthere was no mortality consequent on the operation ; in one-of these, however, the disease returned in the uterus four-months subsequently; in five cases it returned there or else-where within a year; in two within two years ; in or.e

within three years; and in one nearly four years after-operation. But, on the other hand, in 10 cases there was noreturn within a period of four years and in some there wasno recurrence 10 years after the amputation of the cervix.For the relief of pain in cases of inoperable uterine cancerhe recommended conium and orthoform. To mitigate thefoetor of discharge he relied on terebenthene injections,.peroxide of hydrogen, and a 1 per cent. solution of formalin.As local applications in open carcinoma he had experi--enced most benefit from the employment of celandine andmethylene blue.

BRADFORD MEDICO-CHIRURGICAL SOCIETY>-Ameeting of this society was held on April .18th, the Pre-sident, Dr. Berry, being in the chair.-Dr. Eurich gave aMicroscopical Demonstration.-Dr. J. B. Hall showed (1) asmall Dermoid Cyst of the Ovary in which there were threecavities, the first containing hair, the second teeth and bore,and the third a mucoid fluid ; and (2) a Calculus removed sixmonths after lithotrity.-Dr. Kerr showed a case of OpticNeuritis following measles.-Dr. Rabagliati showed the PelvicOrgans with some Intestine removed post mortem froma patient who had suffered from faecal fistula followingpelvic abscess.-Mr. Wilmot showed a patient suffering fromAcromegaly.-Dr. Metcalfe read a paper on the OperativeTreatment of Uterine Cancer. After alluding to a case ofcervical cancer which he had had recently under treatmentDr. Metcalfe discussed the relative propriety of the operationsof supra-vaginal amputation and of vaginal hysterectomy.While admitting that there was a very large body ofmodern opinion in favour of complete hysterectomy he

1298 LIVERPOOL MEDICAL INSTITUTION.

cited Schroeder, John Williams, and others who advo-cated supra-vaginal amputation, and pointed out thatthe immediate mortality from hysterectomy was higherthan from supra-vaginal amputation, while the recur-

.rence rate was no lower. The advocates of hysterectomysaid that the high recurrence rate was due to the fact thathysterectomy had been reserved for more severe cases

while supra-vaginal amputation has been practised on the,early cases. Dr. Metcalfe then described the distribution ofthe pelvic lymphatics and expressed the opinion thatit was impossible by vaginal hysterectomy to remove

the whole of the diseased area together with the

lymphatic glands, and consequently that if the diseasehad spread beyond the limits of the uterus recurrence

was probable after either hysterectomy or amputation of thecervix.-Dr. Rabagliati, Dr. Wood, Dr. Hall, and Mr. Althorpdiscussed the paper and Dr. Metcalfe replied.-Mr. Miall reada paper on Contagion from a Historical Point of View. He.said that disease was in very early times considered to betransmissible by charms and ceremonies, some of which werestill extant. Thucydides records the contagious characterof the plague at Athens, B.C. 430, and about the same timeHermippus, the comic poet, mentions the itch as trans-missible. A little later Isocrates alludes to consumption as’contagious and Aristotle has no doubt of the contagiousnature of the plague. But the strictly medical writers in- Greece before the Christian era ignore contagion. Aretasuswas the first medical author who recognised contagion at all;- this was in the second century A.D. Bubonic plaguecould be traced back further than any epidemic disease;it was now possible to identify it in the sixth century.A.D , when it pervaded the Roman Empire, Easternand Western, for 50 years. According to Gibbon it

depopulated the most flourishing countries, some of whichhave never recovered. For three months from 5000 to10,000 persons died daily at Constantinople. At this timeMayrius looks upon it as decidedly contagious, while Pro-copius, another contemporary historian, denies contagion instrong terms. For a thousand years after this the same disease appeared at intervals in every country in Europe.The recognition of small-pox by Rhazes in the tenth centurywas an important event in the history of epidemics, forthough the disease had probably appeared long beforeit was not properly marked off by physicians. Fromthat time measles, chicken-pox, and ultimately scarletfever, typhus fever, and enteric fever were graduallyanalysed and separated from one another. The belief in

contagion was gradually placed on p firmer foundation.Rhazes does not lay much stress on it, though he admits that Ismall-pox and measles are contagious. He dwells principally on the great susceptibility of children and the less suscepti- I

bility of older persons. There were thus three lines of thought in ancient history in regard to epidemics—the idea of con-tagion, that of the patient’s susceptibility, and that of acommon cause for epidemics. These three theories stillcontended with one another.

],IVERPOOL MEDICAL INSTITUTION.-A meetingof this society was held on April 27th, Dr. Macfie Campbell,President, being in the chair.-Dr. John Hay read notes of’Three Cases of Pulsus Paradoxus. In the first the abnormalpulse condition was associated with the dyspnoea of acutebronchitis in a child, aged three years, and was only a tem-porary phenomenon. The second case was one of pericarditiswith effasion complicated by serous effusion into the right

. -pleural cavity; the removal of -this fluid improved the pulsecondition, but the pulsus paradoxus again became wellmarked without a ie-accumulation of fluid in the pleuralcavity. The third case was one of reversed pulsus paradoxus,the arterial pulsation in the vessels of the right side of theTieck and right arm disappearing during expiration. It was observed in a man suffering from aneurysmal dilatation ofthe arch of the aorta. The cases were illustrated by pulsetracings and charts of the chest conditions.-Dr. Brad-shaw considered that the anacrotic character of the

pulse in the last case was due to the percussion wavebeing largely lost in its transmission through the sac of theaneurysm. It was followed by a slowly advancing tidalwave. The increased anacrotism during expiration was tobe explained by increased interference with the passage ofthe tidal wave.-Mr. Frank T. Paul exhibited a patient uponwhom he had performed Colotomy by a- new method. Thedivided large intestine was conducted ’for some distancebetween the muscles of the abdominal wall and then brought

to the surface. This allowed of efficient control by a lighthorseshoe truss.-Mr. Rushton Parker exhibited a boy whoseRight Upper Extremity had been almost totally Avulsed bymachinery, necessitating the removal of the whole except ashort piece of the clavicle. The subclavian artery had beentorn across. The injection of saline solution into the veinsacted very beneficially.-Dr. Whitford exhibited a patientwho had been more or less under his care and treat-ment for Lupus for a period of 17 years. The patientcame of a very tuberculous family. Some of the scars

as the result of treatment were elastic and almost likenormal skin. The treatment had been scraping withthe application of caustic potash in sticks.-Dr. Per-mewan related a case of Acute Rhinitis which had caused

general infection of the system and in which treat-ment of the nasal condition caused rapid subsi-dence of the fever.-Dr. Carter said that in all cases of

apparently inexplicable fever the nasal cavities shouldbe carefully examined. He illustrated this generalstatement by brief reports of several cases.-Dr.Clemmey in giving an account of a case of Rupture of theKidney said that the patient received a kick from a horseon the front of the abdomen on Sept. 21st, 1898. The firstsymptoms of pain, collapse, retching, and hæmaturia weretreated by fomentations and opium. On Sept. 30th,owing to the temperature rising and pain of a grind-ing character becoming more acute, the loin was openedexposing the ruptured kidney. The rupture extendedhalf-way through the substance, right across the posterior aspect,and into the pelvis of the kidney. Smart bleedingwas controlled by ice and packing followed. On Dec. 6ththe tube was removed and on April 13th, 1899, the woundwas healed. The patient had since followed his employmentas a "timber carrier." In three other cases of severe injuryto the kidney with the ordinary symptoms of rupture nooperation was required, rest, fomentations, ice, and opiumbeing the treatment adopted. Whether secondary lesion ofthe kidney would follow in this case it was at present tooshort a time to say.-Dr. Imlach, Dr. Given, Mr. Paul, andMr. Rushton Parker spoke on the case.-This being the lastmeeting the President briefly reviewed the proceedings ofthe session.

WEST LONDON MEDICO-CHIRURGICAL SOCIETY.-An ordinary meeting of this society was held in the society’srooms at the West London Hospital on May 5th, thePresident, Dr. S. D. Clippingdale, being in the chair.-Dr. Charles Chapman showed specimens of (1) AdherentPericardium in a child and (2) Calcification of the AorticValves.-Mr. H. J. Paterson read a paper on the Use ofGas in General and Dental Surgery. After explaining thathis object was to plead for a more extended use of nitrousoxide aneasthesia he pointed out that although using thesingle work gas" he implied thereby that it was given witha suitable proportion of air or oxygen. It had clearly beenbrought out by Dr. Hewitt that gas should not be adminis-tered except in such combination. The advantages of

gas were its safety, pleasantness, and freedom from

causing after-effects. He contended that it was safe,provided that asphyxial symptoms were avoided, to

prolong nitrous oxide anaesthesia for one or more hoursand recorded a case in which anaesthesia was maintainedby means of gas and oxygen for two hours and 10 minutes.The patient was ready for his tea within half an hour ofhis return to the ward. There was no collapse whatever.Mr. Paterson expressed the view that the action of nitrousoxide was to prevent the elimination of carbon dioxide fromthe blood, so diminishing the oxidative processes of thetissues by a process of "internal asphyxia." There was noevidence that prolonged administrations affected the heartinjuriously, provided that asphyxia was guarded against, andany effect on the heart was due to neglect of this pre-caution. In giving gas the danger signs were readilyobserved and gradually developed, hence he had come to theconclusion clinically that for operations long or short nitrousoxide gas mixed with air or, better, with pure oxygen wasthe safest anassthetic they possessed. Women as a ruletook gas better than men. Heavy smokers, and especiallyheavy drinkers, were bad subjects for this anassthetic. The

danger of passing from gas ansesthesia to chloroform waspointed out. Mr. Paterson expressed the opinion that therewere few operations which could not be performed undergas if desired and many in which this anaesthetic was pre-ferable to either ether or chloroform. Manipulating joints,

1299Xi SCULAPIAN SOCIETY OF LONDON.

pelvic examinations, excision of varicose veins, removal oflipomata, certain operations about the ear, operations of

luxury, such as cure of varicocele or hernia, empyemata,&c., were very suitable for this ansesthetic. Its use in

coeliotomy was at present inadmissible on account of thedifficulty of ensuring freedom from occasional retching move-ments. He strongly deprecated the use of gas as an’anæstheticduring the removal of adenoids. Mr. Paterson then dealtwith the question of prolonging nitrous oxide anæsthesia indental practice and showed his new design of apparatus foradministering gas through the nose. Two female patientswere then anaesthetised by this method by Mr. Patersonwhile Mr. Lloyd-Williams performed some prolonged opera-tions on the teeth. The demonstration was very suc-

cessful.-In the discussion which followed Mr. SwinfordEdwards, Dr. G. D. Robinson, Mr. Starling, Mr. Rickard

Lloyd, Mr. Lloyd-Williams, Mr. McAdam Eccles, Mr.

Bellamy Gardner, Mr. Keetley, and Dr. Chapman took part.ÆSCULAPIAN SOCIETY OF LONDON.-A meeting

of this society was held on May 5th, the President, Mr.D. H. Goodsal1, being in the chair.-Dr. E. F. Willoughbyread notes of a case of Cystic Catarrh in a multipara, aged 45years, who had for two years suffered from severe abdominal

pain, recurrent every two or three days, with vomiting and.subsequent prostration. Her general health was impaired,weight was lost, and the usual symptoms of obstruction tothe outflowing of bile into the intestine were present.Toluylenediamine 0’06 was given for seven days with noappreciable result; then the above quantity was given morningand evening with a result that in two months all symptomsdisappeared.-Dr. Willoughby also read notes of a case ofEndometritis of six years’ standing in a young marriedwoman who was successfully treated by dilatation of theuterus, curetting, and an application of iodo-phenol.-Dr.B. G. Morison read notes of a case of Traumatic SubacuteCerebral and Spinal Meningitis in a man, aged 53 years, onwhose head a picture had fallen. On the fourth day there wasstiffness of the right extensors of the head ; on the sixteenthday the temperature was 39.7° C.; there was acute pain ofthe head, left neck, and body generally. Both knee-jerkswere present but both were absent two days later. On the

twenty-third day there was right facial and parieto-frontalneuralgia with suffusion of that conjunctiva developed.Pyrexia continued for 28 days. In eight weeks from theinjury the knee-jerks were absent but were feebly presentagain in the eleventh week. In the fourteenth week the patientreturned to business well.-Mr. Reginald Brown read notesof a case of (1) Facial Palsy in a 10 months’ infant from a

; known exposure to draught and (2) Cerebral Meningitis in aman, aged 32 years, who had had pleurisy five months pre-

viously. He complained of a sudden onset of ’numbness ofthe tongue spreading to the lower and thence to the upper lip,

right index finger and thumb, aphasia then developing, but thewhole series passed in half an hour. In the next week he had! .five or six of these attacks daily. Later the tongue deviatedto the right with tremor, yet it was possible to protrude itstraight. There was no paresis elsewhere, no optic neuritis,and no albuminuria. There developed some lessened sensa-tion of the right side, increase of aphasia, and later markedfacial palsy with conjugate deviation of the eyes to the right.In a month from the onset of symptoms the patient died.At the post-mortem examination an old psoas abscess, acutepulmonary tuberculosis, and general cerebral meningitismore intense on the left side, were found.

WEST KENT MEDICO-CHIRURGICAL SOCIETY.-The seventh meeting of the forty-third session of this societywas held at the Royal Kent Dispensary, Greenwich-road, onMay 5th, Dr. Morgan Dockrell, President, being in thechair. - Dr. Morgan Dockrell delivered his presidentialaddress on General Health as a Factor in Skin Diseasesand concluded: " I have now only to tender you my thanksfor the very patient hearing you have given to me this even-ing. My object has been to present you more with anabbreviated address than to give you the full text of mypresidential address. The subject is a vast one and wouldnot easily be covered in a couple of hours and so I have pre-ferred to give you the salient points and later those of youwho are sufficiently interested will have an opportunity ofreading the address in extenso. I have to thank you furtherfor the honour you have done me in electing me to thepresidential chair of this society. Gentlemen, this isnot a mushroom society-we rank thirteenth in pointof age among a large number of medical societies which

have sprung up the last 40 years. We have among ourmembers, I should think, the oldest member of the Collegeof Surgeons, our esteemed and worthy friend, Dr. PriorPurvis, who did us the honour for upwards of 40 3 ears toremain our treasurer. We have also as a member probablythe oldest graduate in medicine of the Glasgow Universityand we still number among our members a president whooccupied this chair 34 years ago. Our society is not aloneuseful from its purely medical character, but is also of greatservice in that it promotes the well-being and comradeshipof a large number of men practising in this district. Herewe are able to have all the rough corners knocked off ; ;here we have an opportunity of meeting our fellow prac-titioners and learning to appreciate their true worth and alsoof promoting that harmony which it is so important shouldexist among medical men practising in one neighbourhood.Gentlemen, it is my sincere wish. and I am sure the wish ofall of you, that the West Kent Medico-Chirurgical Societyshould continue to flourish and that it may still go on doingthe good and excellent work in the future which it has donein the past."-After the conclusion of the President’s addressa very enjoyable smoking concert was held. Amongst theartists who kindly gave their services were Messrs. CourticePounds, Carl Brandt, Walter Grace, F. H. Cheesewright(vocalists), Charles Froude (musical sketches), H. WhartonWells (piano), and Dr. Byrd Page (conjuring).PLAISTOW AND CANNING TOWN MEDICAL

SOCIETY.-A clinical meeting of this society was held at thePublic Hall, Canning Town, on April 28th, Mr. Percy Rosebeing in the chair.-Dr. T. D. Lister, pathologist to the EastLondon Hospital for Children, gave an address on Broncho-Pneumonia in Children illustrated by lantern slides. After

dealing with the special anatomy and physiology of theinfantile respiratory organs and the various causes whichpredispose to broncho-pneumonia in children the speakershowed drawings of the various micro-organisms foundin cultures from cases of the disease and explainedthis relation to homologous and heterologous infection.He expressed the view that while all cases of broncho-pneumonia tended in the later stages to exhibit a mixedinfection, primary cases would, as a rule, yield a pureculture in the earlier stages By means of lantern slides

(which were kindly lent by Professor Sidney Martin or wereprocured from specimens in the laboratory of the EastLondon Hospital for Children) the changes excited inthe bronchioles and air vesicles, the various methodsof extension of the inflammation and its results,especially in ’ abscess, fibrosis, and non-tuberculouscaseation, were demonstrated. The post-mortem appear-ances were .then described and a distinction was drawnbetween the disseminated and lobar types of thedisease. The latter the speaker held to be the same diseaseas croupous pneumonia modified by its occurrence in puerilelung and he suggested that the air vesicles were sometimesattacked first by the catarrh. Dr. Lister proceeded toillustrate his remarks upon the diagnosis and prognosis ofthe disease by reference to the charts in typical and atypicalcases and drew the attention of his audience to the splenicenlargement which frequently accompanied an intercurrenttuberculous infection. In speaking of the modern treatmentof the disease he demonstrated a pharmacological basis forthe exhibition of belladonna as now largely prescribed in thewards of the East London Hospital for Children in combina-tion with the usual topical and hygienic measures.-Themeeting, which was well attended, closed with a vote ofthanks to the lecturer.

A DAY OF REST IN THE COUNTRY FOR LONDONNURSES.-For three years past the nurses of the London

hospitals and metropolitan nursing institutions have beeninvited to spend a day at fiertingfordbury. The objecthas been to combine with an opportunity of physical rest thespiritual help afforded by two short services held in the

parish church. By the invitation of Canon Burnside thisprovision will be renewed on Thursday, June lst, when theBishop of Southwark has kindly consented to give theaddresses. The only expense to the nurses will be a railwayfare of 2s. 6d. and those who can be spared from their workwill be warmly welcomed. All information may be obtainedfrom the Rev. A. G. Locke, chaplain of St. George’sHospital, or from Canon Burnside, rector of Hertingford-bury, Hertford.

1300 REVIEWS AND NOTICES OF BOOKS.

Reviews and Notices of Books.A Practical Handbook on the Muscular Ano7nalies of the Eye.

By HOWARD F. HANSELL, A.M., M.D., Clinical Pro-fessor of Ophthalmology, Jefferson Medical College ; andWENDELL REBER, M.D., Instructor in Ophthalmology,Philadelphia Polyclinic and College for Graduates inMedicine. With 28 Illustrations and one Plate. London :H. Kimpton. 1899. Pp. 182. Price 6s. net.

THE functional anomalies of the muscles of the eye haveattracted of late years a large amount of attention in

America and the subject is treated at great length in thetreatises which have been published on the other side of theAtlantic. New terms have been suggested and have beenaccepted, and all ophthalmological treatises now consider

orthophoria, esophoria and esotropia, exophoria and

exotropia, hyperphoria and hypertropia, cyclophoria andheterophoria, conditions which were formerly very imper-fectly described and understood. This present volume

places before the reader in short compass the

symptomatology, diagnosis, and treatment of each ofthese conditions and of the more complex states caused bytheir combinations-such as hyperexophoria and hypoexo-phoria, hyperesophoria and hypoesophoria.- The volumecommences with a brief but exact description of theanatomical features of each of the muscles moving the eye,as well as of the levator palpebras and orbicularis palpe-brarum, with their vascular and nervous supply and theirprecise action. The authors point out that the main symptomsby which ocular palsies reveal themselves are limitation ofmovement, false fixation, diplopia, vertigo, and, lastly, vica-rious rotation of the head. The effects of paralysis of eachof the muscles are given in detail. The means of diagnosisare well given and consist of the prism test, the Maddox rodtest, the convex spherical glass test, the parallax test, thecover test, the cobalt test, and the Maddox double prismtest.

There is a good chapter on Musculo-dynamics, describingthe various instruments which have been devised to deter-mine the power of the muscles to overcome the displacementcaused by prisms put in different positions-such as Risleyand Jackson’s rotary prisms, Stevens’s and Wilson’s phoro-meters, Stevens’s tropometer and clinometer, and Landolt’sophthalmo-dynamometer. In regard to treatment, the

authors contend that it should invariably be inaugurated bycorrection of any optical defect which may be present, thenshould follow in succession the internal administration ofnerve tonics, convergence training, correction by prisms,and, finally, tenotomy. A short section is devoted to this

operation and another to the operation for advancement ofthe several tendons. The book will prove serviceable andshould be read attentively by all who are practisingophthalmology.

A Text-book of Obstetrics. By BARTON COOKE HIRST, M.D.A Text-boo7. of Obstetrics. By BARTON COOKE HIRST, M.D.With 653 Illustrations. London.: The Rebman PublishingCompany. Royal 8vo. Pp. 850. 1899. Price 28s.

. THE valuable contributions of Professor Hirst to theAmerican Text-book of Obstetrics lead us to anticipatewith considerable pleasure the reading of a text-book of mid-wifery written by him alone. In this work the usual

arrangement of considering first the Physiology and then thepathology of Pregnancy, Labour, and the Puerperium is

followed; Obstetric Operations and the Physiology andPathology of the New-born Infant being considered

separately in two chapters at the end.The first three chapters upon the Anatomy of the Pelvis

and Sexual Organs, Menstruation, and the Development ofthe Foetus are good and sufficient. In considering hydram-nios no mention is made of ballottement in the knee-elbow

position or of intermittent uterine contractions as an

aid to diagnosis. The author says that in extreme

distension of the uterus it may be justifiable to resort,

’to an exploratory abdominal section. Surely in sucha case the passage of a uterine sound would at once

clear up’ the diagnosis with much less risk to the

patient. The chapters upon the Diseases of the Fœtus andthe Pathology of the Pregnant Woman are perhaps the bestin the book. We notice, however, one curious omission : no-mention is made of carcinoma of the cervix complicatingpregnancy and nothing is said as to the treatment for sucha condition. In considering the treatment of an ovariancyst in the pelvis complicating labour Caesarean section i&

recommended, together with removal of the tumour. A

better mode of treatment which is not alluded to is ovari-

otomy followed by delivery of the child per vias naturalesthe cervix, if necessary, having been dilated with hydrostatic:dilaters. The section upon Ectopic Gestation is illustrated byan interesting series of photographs from cases of suddendeath due to this condition.

The chapter upon the Puerperium is’full and containsa large amount of practical information for bothstudents and practitioners. The description of obstet-rical operations is, upon the whole, disappointing, andwe must protest against the use of the term "pos-tural version." The correction of a faulty position of thepresenting part by placing the patient upon one or the other,side cannot under any circumstances be called "version andsuch a use of the term is most misleading. Professor Hirstis in favour of Krause’s method of inducing labour andregards the use of dilateable bags with disfavour. So do we,but Champetier de Ribes’s bag, which is not mentioned at

all, is not dilateable and is certainly a most efficient and rapidmethod of causing dilatation of the cervix. This bag onlybursts when it is improperly made or improperly used. Wedo not agree, either, with the author in thinking ccelio-hyster-ectomy preferable to coelio-bysterotomy. If the patient is,

very anxious to avoid the risk of another pregnancy this canbe practically ensured by ligature and division of the

Fallopian tubes without any necessity for the mutilation

entailed by removal of the uterus.

Many of the illustrations are original and of great,excellence ; others, reproductions of photographs, possessall the faults of this mode of illustration. Theypresent a mass of unnecessary detail which preventsthe essential features of the illustration from beingreadily recognised and renders them less useful than

drawings and diagrams would be to the student. We must

protest, too, against the totally unnecessary reproduction ofnude figures at various terms of pregnancy which show

nothing of any value and might well be omitted.Although we have expressed our disagreement with some

of the views put forward by the author, and have had to caUattention to one or two minor omissions, yet we must con-gratulate Professor Hirst upon the production of an originaland eminently readable text-book, and one which is likelyto be appreciated by students not only in America, but alsoin this country.

The Diseases of Children. By JAMES FREDERICK GOODHART,M.D. Aberd., F.R.C.P. Lond., Consulting Physician to theEvelina Hospital for Sick Children, late Physician toGuy’s Hospital and Lecturer in Pathology in its MedicalSchool. Sixth edition with the assistance of G. F. STILL,M.A., M.D., M.R.C.P.Lond., Medical Registrar and Patho-logist to the Hospital for Sick Children, Great Ormond-street. London : J. and A. Churchill. 1899. Pp. 720.Price 10s. 6d.

DR. GOODHART’S book on the Diseases of Children is toowell known to need any remarks from us on its general merits.In the preparation of the present edition Dr. Goodbart has