1379

and the distressing and dangerous depression that occurredwhen patients were suddenly and entirely deprived of thedrug he stated that he was little disposed to follow themethod known as 11 immediate suppression." The methodwhich he adopted was to endeavour to restore the will-powerf the patient whilst gradually lessening the amount of

morphia injected. It was not until the dose per day wasreduced to about two grains that difficulty began. Then for

.every sixth of a grain suppressed hypodermically twice theamount might be given by the mouth or the rectum. Havinggiven up the syringe these doses were made less and less andwere finally discontinued. Digitalis, sparteine, trinitrin, coca,tola, valerianate of ammonia, bromide, and hydrate of amylwere useful adjuncts to treatment.-An interesting discussionensued.

BRISTOL MEDICO - CHIRURGICAL SOCIETY. - Ameeting of this society was held on Nov. 8th in the MedicalLibrary of University College, Bristol, Mr. W. H. Harsantbeing in the chair.-Dr. W. H. C. Newnham showed a specimenof Ruptured Tubal Pregnancy.-Dr. Aust Lawrence, Mr.Paul Bush, Dr. W. 0. Swayne, and the President discussed<the specimen.-Dr. T. Fisher read a paper on (Edemaof the Eyelids with Intermittent Albuminuria in Children.-Dr. Waldo, Dr. B. Rogers, Dr. Edgeworth, Dr. Parker,Dr. Skerritt, Dr. Michell Clarke, Dr. C. Walker, and Dr.Ehingleton Smith commented on the paper.-Dr. MichellClarke read a paper on Two Cases of Sporadic Cerebro-spinalMeningitis and a case of Posterior Basic Meningitis.-Dr..E. C. Williams, Dr. Waldo, Dr. T. Fisher, and the Presidentspoke on the paper.-Dr. E. C. Williams read a paper onBome Points in the Artificial Feeding of Infants.WEST KENT MEDICO-CHIRURGICAL SOCIETY.-

’The second meeting of the forty-fourth session of this.society was held at the Royal Kent Dispensary, Greenwich-road, S.E., on Nov. 3rd, the President, Mr. C. J. Parke,teing in the chair. Several new members having been’-elected, Dr. Arthur P. Luff read a paper on ModernViews as to the Causation and Treatment of Gout which is I

published at p. 1361 of our present issue.-Mr. ThomasMoore by the aid of the Roentgen rays demonstrated the/Case of a Man who had been Shot in the Head.

PLAISTOW AND CANNING TOWN MEDICAL (

SOCIETY.-A meeting of this society was held at the Public 1Hall, Canning Town, on Oct. 19tb, when Dr. M. Handfield-Jones read a very interesting paper on Some Points in thePathology and Treatment of Immature Pregnancies, whichwas followed by a discussion in which Mr. A. Cuffe, Mr. .C. D. Roe, Mr. Percy Rose, Mr. P. N. Jones, and others 1took part. - .. ==== t

NEW SEAMEN’S HOSPITAL FOR CARDIFF.-At ‘the meeting of the Executive Committee of the Cardiff r

Seamen’s Hospital held on Nov. 6th it was reported that the c.amount promised towards the building fund was about a

.621,000, including the .610,000 provisionally given by Lord ’Bute. Lord Bute has extended the period of time duringwhich the necessary amount can be raised to entitle the e’committee to his donation until the close of the year. t

LITERARY INTELLIGENCE.-Messrs. J. & A. d

Churchill have in the press the following new books:- IA Text-book of Medical Treatment (Diseases and Sym-

ptoms), by Dr. Tirard, physician to King’s College Hospital. The arrangement is in the main based upon anatomical and physiological lines, but sections have c.been inserted dealing with symptoms rather than with diseases. The forms of treatment which have receivedgeneral approval are fully indicated and incidentally newerforms of treatment are frequently mentioned, but no attempt B,has been made to say the last word in favour of the newest .remedies.-" A Treatise on Ulcer of the Stomach," by Dr. Fenwick and Dr. Soltau Fenwick. A feature will be the fEnumerous photographs of morbid specimens.-Also a newand revised edition of Dr. Haig’s " Diet and Food Con-sidered in Relation to Strength and Power of Endurance, w

Training, and Athletics."-Messrs. Bailliere, Tindall, and h:Cox will’ shortly publish a fully illustrated work on rhino- plastic operations with a description of recent improvements stin the Indian method by flaps taken from the forehead. Theauthor (Brigade-Surgeon-Lieutenant-Colonel Keegan, late of to

the Indian Medical Service) wrote on this subject inTHE LANCET of Feb. 21st, 1891. pt

Reviews and Notices of Books.Introduction to the Outlines of the Principles of -D4,fferential

Diagnosis with Clinical Memoranda. By FRED. J. SMITH,M.A., M.D. Oxon.., F.R.C.P. Lond., Physician (with careof out-patients) and Senior Pathologist to the Londonof out-patients) and Senior Pathologist to the London

Hospital. London: Macmillan and Co. 1899. Pp. 353.Price 7s. 6d.

THE opening words of the author’s preface are worth

quoting: " The number of works on medicine and its various

quasi-special branches that claim the time and attentionof over-burdened students and practitioners is so great thatonly one excuse should be offered for adding to it-viz.,either to say something new or to put forward a morerational and simpler arrangement of what is old. Verylittle that is new will be found in the following pages,but I claim that I have attempted to arrange the old,old phenomena of disease in such a manner as to show moreclearly their fundamental meanings and relationships."Intending authors would do well to ponder these expressions.Medical literature as a whole would benefit greatly, althoughEngland does not suffer so much in this way as do some othercountries. Dr. Smith, however, is very modest in the wayin which he introduces his book. The facts are for the most

part not new, but they are arranged and discussed in

a manner which is quite original and which is deserv-

ing of the highest praise. Students preparing fortheir examinations will find the principles of diagnosisarranged in a manner that will be of the greatest valueto them, whilst practitioners will find the volume of greatuse as a work to refer to when dealing with a puzzlingcase. It is a book, however, that requires a little studybefore the ideas of the author can be fully understood, butwhen once its general scope and arrangement have beenmastered it will be found to set forth the principles ofdifferential diagnosis in a new and advantageous mannerthat is both delightful and instructive.The first chapter is headed Introductory Remarks on

Diagnosis in General. It requires very careful reading ; thestyle in which it is written does not allow of mere skimming,but each paragraph has to be attentively followed. Thewhole chapter is replete with the results of original thought ;

.

the remarks on Micro-organisms and Zymotic Diseases arealso written in a strain unusual in medical works and all themore pleasing on account of the change. The analogydrawn between the invasion of the body by specific germsand the invasion of a geographical country by a hostilenation is very taking. Dr. Smith suggests that " the differ-ences between the engaging forces are almost nothing butthose of size and the nature of the weapons used."We can speak very highly also of Dr. Smith’s method of

discussing the diseases of thoracic organs. The section on

Laryngeal Affections is particularly well done and the pointsbo be noticed in the differential diagnosis of ulcers of thelarynx and "laryngeal paralyses " are set forth with unusualclearness and the student will derive much sound information’rom a study of these pages.Dr. Smith is perhaps at his best when discussing Cardiac

Bruits and Sounds that may be Mistaken for Them. Through-)at the whole book the use of tables is freely taken advan-age of to correlate and contrast the most distinguishingeatures of various classes of symptoms, and in describing:ardiac murmurs such tables are especially applicable ; thusve find contrasted pericardial with endocardial sounds,ioemic with organic bruits, and the "value of origin of)ruits of organic origin." By glancing at such tables thetudent is at once able to inform himself in matters difficulto learn and easily forgotten.The chapter on Differential Diagnosis of Some Sym-

ptoms and Affections of Nose, Throat, aid Alimentary

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Tract and Annexa also contains a vast amount of tr

information chiefly in the form of tables. This manner w

of expressing facts may in some cases lead to confusion, w

but Dr. Smith has drawn up his comparative columns with so much thought and skill that the arrangement is tlan excellent one both for study and reference. One of Ci

the best sections is that entitled, ‘&deg; Causes of Abdominal tc

Pain." This symptom is often a most difficult one for dthe practitioner to interpret, and as so many abdominal n

eomplaints, some of minor consequence and others of T

the utmost importance, have pain as the most prominent c’

symptom, it is often a grave cause of anxiety to him o

as to the exact nature of the complaint. On glancing ii

over Dr. Smith’s remarks, however, numerous suggestions t(

will be found, and acting on these hints the correct dia- c

gnosis will probably be quickly arrived at. Another chapter a

to which we may draw attention is that on Affections of a

Joints, wherein will be found much that is interesting. We b

think, however, that the author has not been so fortunate asusual in his selection of terms. In electing to consider s

"rheumatic gout " a separate affection from chronic a

rheumatism, gout, or rheumatoid arthritis, he has rather e

added to the confusion that already exists. He himself v

speaks doubtfully on the subject, for whilst allowing that v"the very existence of such a disease is denied by many," 1

yet he says : " I certainly feel inclined to admit its e

existence-at least, the existence of more than one factor i

producing the joints called rheumaticgouty ; though I must a

admit that many such cases are nothing but gout, and many t

are true rheumatoid arthritis." Perhaps Dr. Smith wouldhave done better to follow the nosology of most modern c

writers and taken rheumatic gout " as a synonym of c

" rheumatoid arthritis." The Differential Diagnosis of Diseases of the Nervous c

System is most difficult to discuss on account of the r

great advance which has been made in our knowledge in this branch of medicine. The author therefore wisely entersrather fully into the anatomy and physiology of the nervoussystem, for without fully understanding the arrangement of the cells and fibres an accurate understanding of the diseases affecting the brain and spinal cord cannot be arrived at. Throughout this chapter a good deal of originality is dis-played and the complicated phenomena which have to be

investigated are set forth in as plain terms as possibleand no pains have been spared to render the working-outof intricate problems as simple as can be done’in words.The differential diagnosis of organic and functional diseasesis carefully considered, especially in relation to disseminatedsclerosis, which disease perhaps is more difficult to differen-tiate from functional disease than any other. We havesearched the book in vain, however, for any reference to the

many symptoms of neurasthenia which simulate organicdisease, more especially in relation to the gastric phenomenawhich are so common and so puzzling. Cases with haveresisted all the ordinary treatment for dyspepsia or chronicgastric catarrh yield in a wonderful manner when regardedas cases of neurasthenia and treated as such, but beforedoing so a correct diagnosis must be arrived at. However,future editions of the work are sure to be called for and thisomission can be then rectified.We consider this to be one of the best books on differential

diagnosis which we have met with and heartily congratulatethe author on the success of his labours.

Over-press,ure. By S. DE BRATH and F. BEATTY. London :George Pnilip and Son. 1899. Pp. 236. Price 3s. 6d.

WE have read this book with satisfaction, showing, as itdoes, that members of the teaching profession are desirousof applying the principles of physiology to the care and

,raining of the brains of their pupils. The volume openswith some account of the nervous system culled from modern.writings on physiology ; this is well expressed and forms a:.

ood introduction likely to impress teachers with a sense of,he delicacy of the brain processes expressing mind and the.are necessary in directing them. When the authors proceedhe quote evidence as to the increase of neuroses andlecadence in development of the body we think the pessi-mistic side of average school-life is somewhat exaggerated.The introductory chapters form a useful prelude to the dis-cussion of coordinated education which is the subject matterf the book and which the authors appear to have worked outin practice. We should like to have seen attention drawnto methods of physical training and especially to thosecoordinated exercises which control modes of brain action

among the higher centres and effect much in cultivating theaptitude for expressing mental processes and generally inbrightening the child’s action.

Speaking of memory we read : " No argument is needed toshow how much more impressive must be the teaching whichappeals to two or three senses, and, linked to the child’s pastexperiences, becomes part of the fabric of his life, than thatwhich appeals to the single sense of hearing by means ofwords." This principle may be safely accepted, but it is a.

long step to pass from the study of the brain and nervous.energy to mental economics in school life unless the readeris well acquainted with, and practised in observation of, theaction and inter-action of the nerve centres as indicated bythose visible " nerve-signs " to which the authors make brief’allusion. We would draw attention to the need of cultivatingother faculties besides the sense organs proper, such as mus-cular sense in movements when counting with the band andfingers and in looking at objects one after another. The feelingof weights and of size may be employed as an elementarymeans of appreciating proportion before the verbal rules andmethods of arithmetic are taught Mr. de Brath says thatin his experience " if a child has been well taught up to eightyears old he should then be able to realise the actual opera-tions of simple addition, subtraction, multiplication, anddivision, but this is very rarely the case." Better educa-tional results with less early difficulty to the pupil might.follow the method of making the child feel the addition of-’weights, and appreciate their proportion by muscular sense-before teaching the use of symbols or visualising the figures-mentally as he makes a calculation. A happy method ofteaching history ancient and modern is described, includingboth pictures and objects such as arms, dress, pottery, andornaments, while stories characterising the historical periods-are narrated in class as likely to become fixed landmarks inthe imagination of the child.

We are unwilling to express an opinion upon the scheme ofinstruction sketched out for the occupation of school classes’from the age of eight up to that of 18 years; it concerns us.

rather to see whether the advice given in this book is basedupon sound principles, thus avoiding both mental confusionand educational over-pressure. Healthy mental growth, as.well as health of the body, requires that each separate facultyshall be cultivated, then employed; thus, when the childhas appreciated the meaning of numbers and proportionthese may be employed in the study of natural objects and inarithmetic. Memory is not cultivated by simply giving thepupil a task to learn and to repeat : the child should hear thepassage read aloud and be directed to read it for himself,while the association of leading thoughts is indicated to him.Objective teaching is all-important in cultivating retentive-ness of instruction. We agree with the authors that all thesenses should be brought into play-for this reason actualcoins should be used which enable the child to realise their

conversion, and that the weight of tea bought is directlyproportional to the weight of money spent in the pnrctiaae :.

this the child can be made to feel. The book is well written

1381

and readable ; but a table of contents and an index wouldhave been of much use to the reader.

Microscopische Technik zum Gebrauch bei Medicinischenund Pathologisch-Anatomischen Untersuchugen von Pro-fessor Dr. CARL FRIEDLAENDER. Sechste vermebrte undverbesserte Auflage. Bearbeitet von Professor D. C. J.EBERTH in Halle. Mit 86 Abbildungen im Texte.Berlin : Fischer. Microscopic Technic in Use in the

Medical, Pathological, and Anatomical Researches of Dr.CARL FRIEDLAENDER Sixth edition, thoroughly Revisedby Professor D. C. J. EBERTH of Halle. With 86 Illustra-tions. Berlin: Fischer.) Pp. 358. Price 9s.

THE plan of this excellent handbook of microscopictechnic is a division into three parts : the first, which is verybrief, deals with the different forms of microscope, theutensils and instruments in common use, and the ordinaryreagents, such as alcohol, ether, acids, and alkalies. The

second part is devoted to the methods of investigation,separate chapters dealing with the processes of isola-tion and maceration of tissues, fixing, hardening, decalci-fying, injecting, and preparing them for section, makingsections, staining, impregnation with metals, as with goldand silver, osmium and iron, means of rendering trans-parent, preservation and mounting of specimens, the

camera lucida, and micro-photography. These two partsoccupy the first half of the volume. The last half is devotedto the various modes of treatment which have been suggestedto demonstrate details of structure in the different organsof the body. Nothing shows better the immense amountof labour that is at the present time being bestowed uponthe microscopical preparation of the nervous tissue than thevariety of hardening, staining, and mounting methods whichare here described, and we venture to take this tissue as asample of the plan pursued by Professor Eberth on thelines originally laid down by Professor Friedlaender. Aftersome general observations on the effect of Muller’s

fluid, osmic acid, corrosive sublimate, and nitric acidon the nervous elements, the following methods

are given in detail : the staining of degeneratednerve-fibres by the method of Marchi and Algeri; the

staining of nuclei by von Gieson’s method and the

staining of ganglion cells (under the latter head are

described Nissl’s method of staining with magenta redand with methylene blue); then follow Sadorski’s, Held’s,von Lenhossek’s, Heimann’s and Rosin’s modified Nissl’s

methods; next come Golgi’s chrome silver and sublimatemethods-Ramon y Cajal’s method which is well adaptedfor the retina-K&ouml;lliker’s modification of this process,Cox’s, Obregia’s and Flechsig’s modifications of Golgi’smethod, Kallius’s method, Ziehen’s mode of staining thecentral nervous system, Weigert’s mode of stainingmedullary sheaths, Haug’s and Pal’s improvements on thismethod, Kulschitzky’s method, Wolter’s process, Kaiser’s

quick stain with iron-chloride-h&aelig;matoxylin, Exner’s, Adam-kiewicz’s, and Nikiforoff’s methods adapted for medullatedfibres, Schmaus’s uranium carmine stain for axis cylinders,Czokor’s alum-cochineal method, Sahli’s method, Stroebe’sanilin blue-saffranin stain, Gerlach’s, Freud’s, and Upson’sgold stain, Spaink’s nigrosin - saffranin plan, Mallory’sphosphor-molybdic acid and h&aelig;matoxylin stain, and Wolter’svanadium stain. There are still others for the neuroglia andothers again like Stroebe’s method, Obersteiner’s iron chloride-dinitro-resorcin method, and Lowit’s, Kuhne’s, Ranvier’sGolgi’s, May’s, and Ehrlich’s plans for demonstrating theperipheric nerve-endings. All these proceedings, it will be

remembered, are directed to the elucidation of the details ofstructure of the nervous system alone and the number ofGerman names which we have quoted shows how congenialthis kind of work is to our painstaking and earnest colleagueson the continent. We should add that in each case not only

the order in which the sections should be immersed in the

several solutions of salts, but the time during which

exposure is requisite to their action to obtain the best

results are given with great precision. To those who can

read German the work will prove invaluable.

Atlas of Urinary Sediments. By Dr. HERMANN RIEDER Ofthe University of Munich. Translated by FREDERICKCRAVEN MOORE, M.Sc., M.D. Vict., Assistant Lecturerand Demonstrator of Pathology, Owens College. Editedand Annotated by. SHERIDAN DEL&Eacute;PINE, M B., C.M.Edin., B.Sc. Lausanne, Professor of Pathology in OwensCollege and Victoria University, Manchester. 36 Plates,comprising 167 Figures (many in colours) and severalFigures in the Text. London: Charles Griffin and Co.1899. Pp. 111. Price 18s.

WE offer our congratulations to all those concerned in theproduction of this atlas. It may be pronounced a success inevery way. The plates are faithful and good representationsof urinary sediments and are most beautifully executed andreproduced. One of the most puzzling features in theexamination of urinary sediments is the polymorphism ofthe commoner forms, and students are especially apt to beperplexed by them. Dr. Rieder has therefore paid especialattention to these variations and a large number of themare figured. Especially is this the case with the oxalates,phosphates, uric acid, and the urates. It would be of greatvalue if these plates could be enlarged for use in lectures.The colouring of the microscopical specimens is very goodand true, but the artists have not been so happy with therepresentation of the naked-eye characters of the urinarydeposits, which cannot be said to be faithful reproductionsof test-tube specimens. The drawings of the urinary castsare excellent and are by far the best we have seen. The text

of the work is also well put together and special referenceis made to the clinical significance of the sediments.The publishers were fortunate in securing the services ofProfessor Delepine as editor. The additions to the text areconsiderable and valuable. We cordially commend the workto the notice of our readers.

JOURNALS.

Annales de Gyn&eacute;cologie et d’Obstetrique. October, 1899.Paris : G. Steinheil.-This number contains a Note upon the

Histology of the Corpus Luteum, by M. V. Cornil ; SurgicalTreatment of Fibro-myomata of the Uterus, by ProfessorSchauta ; and the Report presented by Professor Leopold tothe Amsterdam Congress upon the Indications for CassareanSection, Symphysiotomy, Craniotomy, and the Induction ofPremature Labour. Professor Leyden reviews a case of

Puerperal Tetanus treated by Injections of Antitoxinunder the Dura Mater, and a summary of some Russianmedical articles and the usual bibliography conclude thenumber.Revue de Gyn&eacute;cologie et de C7tirurgie Abdominale.

September and October, 1899. Paris: Masson et Cie.-The

original articles include a Report upon a Rare Form of

Hasmorrhagio Metritis, by M. S. Pozzi and M. P. Latteux;Pyometra as a Complication of Cancer of the Cervix, by M.F. Legueu and M. P. Rebreyent; Symptomatology of SolidTumour of the Ovary, by M. L. Dartigues; Upon the

Tumours and Inflammatory Contractions of the PyloricRegion of the Stomach and the Ileo-cseoal Segment of theIntestine, by M. Gerard Marchant and M. A. Demoulin ; andLigature of the Splenic Vessels in Hypertrophic Lesions andHaemorrhages from the Spleen, by M G. Carriere and M. J.Vanvert&. An analysis is given of current gynagcologicalliterature and there is a short account of some of the more

important papers read at the Amsterdam Congress of

Gynascology and Obstetrics.