the electric test cannot do, although it may, in some cases, help the complainant to establish his injury. Neither is the author's statement correct, that (1) the paralysis resulting from railroad accident must necessarily be spinal, and that (2) electricity can be depended on to diagnose cerebral from spinal paralysis for the following reasons: (a) A railroad accident may so injure a passenger that concussion of the brain, with extravasation or hemorrhage may take place and cause cerebral paralysis, without injury to the spine. (b) In such cases electrical diagnosis would be almost useless, since the general diagnostic symptoms would be quite sufficient to indicate the nature of the resulting paralysis. But even if the electric test were employed, but little would be gained, for cerebral paralysis would react normally, like peripheral muscular paralysis, or like paralysis from injury or disease of the cord or meninges above the origin of motor nerves supplying the parts paralyzed. Electro-diagnosis is, therefore, in our estimation, a useful adjunct, but reveals nothing tha: could not be clearly established without its aid. For where there is a complete failure of reaction to the electric current, this absence is due to serious traumatic lesion or atrophy of the muscles-both conditions sufficiently apparent to the touch and eye. Pseudo-hypertrophic paralysis, however, must be excepted, in favor of electricity. We do wish we could blot out pages 142 and 143. Without them, the work would be a perfect one of its kind. The paper, type and illustrations are most excellent. D'ARY. THE DISEASES OF WOMEN: THEIR PATHOLOGY, DIAGNOSIS AND TREATMENT INCLUDING THE DIAGNOSIS OF PREGNANCY. By Graily Hewitt, M. D., F. R. C. P., Professor of Midwifery and Diseases of Women in University College, London, etc., etc. Fourth American, from the third revised and enlarged London edition, with one hundred and thirty-two illustrations. Paper; pages, 751. Price, $1.25. Philadelphia: P. Blakiston, Son & Co., 1882. For sale by John Moore, Ann Arbor. Dr. Hewitt has long been favorably known as an authority upon diseases of women, and we are glad to see this new edition of his work issued in such a form as to place it within the reach of every medical student and practitioner. The author states that this edition is substantially a new work, as it has been re-written and much enlarged. It contains the generalizations which have appeared to the writer during his long experience. Most writers upon this subject base all their theories of uterine pathology upon inflammation, and do not attempt to explain the cause of the inflammation. Dr. Hewitt states that there must be some peculiar conditions leading to the inflammation, and he bases his studies upon these conditions. In other words, while many writers consider only a symptom, he en deavors to ascertain the cause of the symptom. These causes are almost invariably found to be certain mal-positions of the uterus, as the various flexions. For this reason Dr. Hewitt's work has been called a "mechanical system." He gives at the outset the following statements: 46 (a) Patients suffering from symptoms of uterine inflammation (or, more properly, from symptoms referable to the uterus) are almost universally found to be affected with flexions or alterations in the shape of the uterus of easily magnified character, but varying in degree. (b) "The change in the form and shape of the uterus is frequently brought about in consequence of the tissues of the uterus being previously in a state of unnatural softness, or may be often correctly designated as chronic inflammation. (c) "The flexion once produced is not only liable to perpetuate itself, so to speak, but continues to act incessantly as the cause of the chronic inflammation." Generally there are good reasons for placing flexions first in the order of sequence, and in some instances the flexion may be brought about by over-straining, as after parturition, or from accidents due to over-exertion in the non-gravid state. It must not be thought, however, that all uterine pathology hinges on flexions. The uterus is liable to diseased states from other causes, as cancer, fibroid tumors, etc. But the majority of cases met with are due to flexions. Some statistics are given, showing the frequency of flexions in uterine diseases, but we think that most practitioners will agree with our author on this point. We have not space to enter upon a further analysis of this volume; but we may say that upon this practical foundation a work of great value to the physician has been produced. DISEASES OF THE LIVER, WITH AND WITHOUT JAUNDICE, WITH THE SPECIAL APPLICATION OF PHYSIOLOGICAL CHEMISTRY TO THEIR DIAGNOSIS AND TREATMENT. By George Harley, M. D., F. R. S., Fellow of the Royal College of Physicians; Physician to University College Hospital and Professor in University College, London. Illustrated by colored plates and wood engraving. Cloth; pages, 751. Price, $5.00. Philadelphia: P. Blakiston, Son & Co., 1882. As an expert in physiological chemistry, Dr. Harley is especially fitted for the study of the liver and its diseases. No one without special study in physiological chemistry is in a condition to study this organ. The chemistry of the bile, of its formation and its decomposition, must be understood. The glycogenic function of the organ must be studied, and also its effects upon nitrogeneous foods. Then, again, only the chemist is able to thoroughly study the urine, the composition of which is so often an index to the condition of the liver. Dr. Harley has possessed, as thoroughly as any one of the present day, all this knowledge, and he has used it to excellent advantage. He has produced a work which we predict will not only be authoritative at present, but on account of its advanced thoughts will become a classical work. The author holds that the errors, which one every day sees committed in the differential diagnoses of diseases of the liver, are not, as he believes, due to uncertainty of their symptomatology and the inherent difficulties attached to their signs, but to the defective means adopted by physicians in attempting to unravel them. This, moreover, is not due to absence of means so much as to a disinclination to take the trouble of using them. The clinical teacher spends hour after hour with his students over patients with thoracic troubles, but neglects almost wholly, derangements of the liver. This arises from inadequacy of knowledge, on the part of the teacher, of physiological chemistry, which "is the only talisman which can unravel the tangled skein of secrets which involves the vast majority of hepatic disorders." The various facts to be learned and the errors to be avoided in percussion of the liver are given. The author considers this organ as performing four distinct functions. These are: (1) a sugar manufacturing, (2) a fat modifying, (3) a calorifying, and (4) a bile forming function. The statement that liver forms milk-sugar as well as glucose seems to us to rest on insufficient grounds. It is more likely true that the mammary gland converts glucose into milk-sugar. Milk-sugar has never, so far as we know, been found in any other fluid of the body than milk. The signs and symptoms of hepatic diseases and the methods of making differential diagnoses are given with great clearness. Then follows a chapter on hepatic remedies. The action of mercury in causing the expulsion of the contents of the gall bladder and in indirectly stimulating the secretion by releiving congestion is pointed out. Under the head of "dietetics in diseases of the liver," the author gives the following rules: (1) All fatty matters are to be reduced to a minimum, and butter and bacon totally avoided in the vast majority of hepatic diseases. (2) "All salted and special foods are to be shunned, such as corned beef, ham, sausage, Finn an haddocks, and all other kinds of salted fish. (3) "All river fish are to be eschewed; salmon, trout and eels more especially. On the other hand, white sea fish in the shape of cod, sole, turbot, whiting, smelts, and dabs may be taken with impunity; but mackerel, pilchard, fresh herrings and sprats, ought not, as a rule, to be partaken of. (4) "Pastry-whether as pie or tart crusts-dumplings, plum-pudding, and all heavy starchy and sweet dishes, are to be avoided. Whereas, plain arrow-root, sago, tapioca, and such like light and pure farinaceous dishes, may be moderately indulged in. (5) "The lean of mutton and beef is a better animal food because more nourishing and digestible than poultry or game. Pork, lamb and veal, being less nutritious, are to be avoided. (6) "Beers and porter, port, madeira and sherry, are more likely to do harm than weak gin, whiskey or brandy and claret, hock or champagne." The shameful adulterations practiced in making the socalled dry champagnes for the English market are pointed out. They are not dry, but sour wines, as sour as vinegar and thus frequently cause hepatic troubles. Under the head of "general remarks on special forms of treatment," the following rules are given: (1) "In the early stages of all cases of acute and severe hepatic diseases, an avoidance of rich nitrogenous foods is indispensable. No solids whatever should be given, and nitrogenous food only in the shape of beef-tea and milk. Slops is the word which most graphically defines the suitable diet, and of those, as every one knows, there is an endless variety to select from, so I need not waste time by enumerating them. Fruits when in season, such as grapes, oranges and strawberries, will, if the patient can take them, do good. (2) "Let the patient drink freely. The more he drinks the better, for it favors elimination by kidneys, skin and lungs. In all cases attended with pyrexia, give iced beef-tea and milk, the juice of a fresh lemon, or better still, a lime in a bottle of aerated water, dilute raspberry vinegar, or anything else of that kind. Oxygenated water I have found both palatable and refreshing to the patient. (3) "If the temperature of the body be high, reduce it by the application of ice-bags to the extremities, or even to the abdomen; but never to the chest, for fear of producing complications. Always take care that the ice-bags are changed from place to place, or the skin may be frost-bitten, an accident which occasionally occurs when the freezing mixture is kept too long on one place. "The plan of placing the patient in a cold water bath is not nearly so good as the applying ice-bags; first on account of its exhausting effects, and secondly the trouble. When patients can afford it, a water mattress, in which the water can be frequently changed, may be used. "In the treatment of some of the more common forms of pyrexial disease, this plan has been successfully adopted at University College Hospital, the Manchester Infirmary, and elsewhere. Where the above methods are inapplicable, begin by putting the patient into cotton sheets. Dispense with everything woolen. Sponge the whole of the body piecemeal (keep ing all covered but the part being operated upon) with vinegar, milk or eau de Cologne and water, twice or thrice a day, for it is not only a cooling but a refreshing process to a feverish body. (4) "When the pulse is high, and the patient's strength will bear it, reduce it by half or drop doses of the pharmacopoeial, tinctura aconiti, or twenty minim dose of tincture digitalis given every hour or two; but stop the administration of either drug the moment the pulse falls to eighty. To be resumed if and when necessary. (5) "Vomiting subdue by cold effervescing salines. of soda, potash, magnesia, and of caffein, will be found useful. (6) "Diarrhoea control by chalk mixture, krameria, kino, and other such like forms of astringents. (7) "Hemorrhage. As the causes of intestinal hemorrhage, which occasionally takes place in the course of cases of liver disease, are very various-occurring as it does in perforating gall-stones, contagious jaundice, and in chronic as well as in acute atrophy of the liver, a correct diagnosis of its cause must necessarily precede the selection of the plan of treatment. But in general terms it may be said that while, in cases of traumatic hepatic hemorrhage, ice-bags may be applied to the abdomen, in most of the other forms the repeated administration of R. Pulv. Aluminis........ Acidi Sulph. Aromat.. Fetri Sulphatis... Syrupi Tolutani.. gr. x. mp xxv. will in general be found of great service. A new form of hæmostatic introduced from America is Hazeline (the active principle of the bark of the witch-hazel), which in doses of from thirty drops and upwards is likewise efficacious. (8) "When cerebral symptoms appear, apply, without a moment's delay, a freezing mixture of salt and pounded ice, in a water-proof bag, to the head; and never forget to keep the part of the bag in contact with the skin moist with water, as dry waterproof cloth is a bad conductor of cold. Liquor ammoniæ acetatis is useful in large doses, so also is James's Powder. (9) "In order to procure sleep. never give an opiate, if it can be avoided, in consequence of its tending to stop the action of the liver, as well as that of the kidneys and bowels; first try the bromide or chloride of ammonium, and, if they will not do, chloral, lupuline, or hyoscyamus. (10) "Keep the room as quiet as possible, the patient from speaking, and garrulous friends from approaching him. Stop his ears with cotton wool, and shade his eyes from light by dark blinds or a properly arranged screen, whenever there are the slightest cerebral symptoms present. (11) "The temperature of the room should, when possible, always be maintained at between 60° and 65°. In summer, the reduction from a higher temperature to the above is most |