mucous membrane and an irritating poison in the blood. Dr. Barnes considers the exceptional occurrence of albuminuria of gestation and scarlatina, and the frequent complete recovery of the kidney in both, exclude the theory of inflammation or Bright's disease as a rule. In both cases it is true that the physiological process is strained to the verge of endurance; in some cases, indeed, the boundary is forced, and physiology yields to pathology. The general indications for treatment in all cases of albuminuria, physiological and pathological, are to take off the strain from the kidneys as much as possible, by making the correlated organs-the skin, lungs, liver, and intestines-do full work in elimination. NEW PUBLICATIONS. INSANITY: ITS CLASSIFICATION, DIAGNOSIS AND TREATMENT. A Manual for Students and Practitioners of Medicine. By E. C. Spitzka, M. D., President of the New York Neurological Society; Formerly Physician to the Department of Nervous Diseases of the Metropolitan Throat Hospital; Consulting Neurologist of the North-Eastern Dispensary; Neurologist to the German Poliklinik, etc., etc. 8vo: four hundred and twenty-three pages. Cloth, $2.75. New York: E. B. Treat, 1887. The author of this work is well known to both the medical and the legal profession, as an eminent neurologist and authority on mental diseases. The first edition of this manual was used by members of both profession as a book of reference in medicolegal cases. Many changes have been made in the present edition embodying suggestions which the author received from distinguished fellow alienists. The author's discrimination in the first edition, between "systemized" and non-systemized delusions, has been generally adopted and is retained in this work. In this work "Paronvia" is considered as preferable to "Monomania." The author considers the statements regarding existence of moral imbecility "have received such potent support by the recent contributions of D. Hack Tuke, Workman and Hughes, not as he mentioned a host of continental authors, that it ceases to become necessary to longer regard this disorder as a subject of controversy." The various forms of insanity, as defined and described by the author, loose their complexity and vagueness. In these days every physician is expected to possess a useful knowledge on this subject. Those who do not will find his efforts toward that end greatly facilitated by study of Dr. Spitzka's work. WHAT TO DO IN CASES OF POISONING. By William Murrell M. D., F. R. C. P., Lecturer on Pharmacology and Therapeutics in the Westminister Hospital; Examiner in Materia Medica in the University of Edinburgh and to the Royal College of Physicians of London, etc. First American from the Fifth English Edition, Edited by Frank Woodbury, M. D.; Fellow of College of Physicians of Philadelphia; Professor of Materia Medica, Therapeutics, and of Clinical Medicine in the Medico Chirurgical College of Philadelphia, etc. 12mo: one hundred and fifty-seven pages. Cloth, $1.00. Philadelphia: The Medical Register Company, 1887. This little work was made to fill a want, and the author was eminently successful. In a short period it reached in England, its fifth edition. The sale of the American we are sure will be equally extensive. The contained material is most concisely stated, and arranged so that the minimum of time will give the desired information. The poisons are considered in alphabetical order, but a classification is made, by grouping the drugs that produce the same toxic symptoms and conditions, as, the patient is paralyzed: Physostigmine, conium (from below upwards) gelsemium, aconite, arsenic, lead. In the American edition the American pharmacopoeial nomenclature is given, and other modifications to adapt it to the use of the American physician. This little book is a necessity to every practicing physician, and intelligent laymen, and a copy should be found in their libraries. MEDICAL PROGRESS. SURGERY. SOME RETROSPECTIVE AND PROSPECTIVE THOUGHTS ON SURGERY.* BY DONALD MACLEAN, M. D., DETROIT, MICHIGAN, Our generation has witnessed one of the most active and progressive eras in the history of that department of medical science to which the attention of this Section is especially devoted. It has occurred to me that a concise and candid statement of some of the impressions made upon my own mind and some of the conclusions at which I have arrived as the * Delivered at the Thirty-ninth Annual Meeting of the American Medical Association, Cincinnati, May 8, 1888. result of active experience, extending over a period of at least a quarter of a century, might not be altogether uninteresting to this Section, which has conferred on me the great honor of electing me its chairman; an honor which carries with it the responsible duty of delivering an address on the present occasion. The vastness of the subject and the shortness of the time at my disposal necessitate a brevity and conciseness of style which might easily be construed as implying a spirit of dogmatism, which is now, once for all, emphatically disavowed. It is possible to hold well-defined opinions and still be tolerant of those who differ from us; and no one could approve or admire the spirit of scientific skepticism more than I do. So that it goes without saying that I freely and fully concede to every one the right to judge for himself how much or how little of what is here said he shall accept as true. Any one who will reflect for a moment how often he has had occasion to modify his opinions on important surgical matters will surely hesitate a good while before venturing to be censorious toward those who fail to accept his views or his methods of practice. Not only so, but as we look around us and observe the almost diametrically opposite views which authorities of equal eminence hold on the same subject, we cannot but feel that it is absurd and presumptuous for any one to attempt to dictate to his brethern in the profession what they shall accept as final truth in surgery. One thing is certain, that the progress of surgery during the last quarter of a century has been unprecedented. To correctly analyze the methods and the results of this wonderful period of activity, winnowing out whatever has proved to be false, misleading or unreliable, and giving proper significance and credit to the genuine and the permanent, is a profitable employment and a true labor of love for the scientific student and practitioner of surgery. Without claiming for myself any special fitness for this work, the mere fact of my election to this honorable office encourages me in the hope which I have expressed, that a frank statement of some of the opinions which my observations and experience have led me to form may be listened to with interest by my present audience. Perhaps, too, the fact that I have been actively employed during almost the entire period of my professional life in the work of teaching surgery to large classes of medical students may add somewhat to the interest . of such a summary of my views on a few of the great surgical problems of our day as I here propose to make. The marvelous progress of modern surgery in our time is commonly attributed to two great agents, namely, anaesthetics and antiseptics. But with all due deference to these, it should not be forgotten that they themselves are only part of the fruits of a great general movement all along the line of the natural sciences, and that the advances in anatomy, chemistry, physiology, histology, etc., have contributed in innumerable ways to the progress of surgery; and it is no more than just that the great army of able and enthusiastic laborers in these collateral departments should receive adequate recognition for the services which they have rendered, directly or indirectly, to surgery. Nor should the fact be overlooked that even before the beginning of the present surgical era, that is, before the introduction of anesthetics, and long before antiseptics were dreamed of, surgery was a great scientific art, and many of the principles and the methods promulgated and taught by our fathers stand unchallenged and unchanged to this day. To those great minds who cultivated and practiced surgery without the aid of our "modern conveniences," it is impossible to concede too high a meed of praise. The least we can do is to acknowledge with greatful candor the extent of our indebtedness to them. That the introduction of anaesthetics constitutes one of the most important events in the history of surgery is a fact generally conceded; and still it seems to me that, in trying to explain the rapid progress of our art in recent times, a mistake is often made in attributing to other causes a good deal that is really due to this. For example, it is a common thing nowa-days to hear much, if not all the credit of the wonderful advances in the surgery of the abdomen, the surgery of the articulations, the surgery of the blood-vessels, etc., given to Listerism, or antiseptic devices. Now, the fact is that antiseptics without anaesthetics could have had but a comparatively limited and insignificant field of usefulness; and before attempting to decide or define the true value of antiseptic processes, let us try to do justice to some of the other factors in this interesting problem. The introduction of anesthetics at once enlarged the field of operative surgery, in the first place by enabling patients to undergo operative procedures which otherwise could not be endured; in the next place, by enabling many persons to cultivate and acquire operative skill and experience who, without the aid of anaesthetics, would have shrunk from the dread ordeal of performing a surgical operation. The introduction of anæsthetics inaugurated an era of unprecedented enthusiasm in the cultivation of every department of surgery. And out of this, as a necessary and natural consequence, has come the splitting up of surgery into subdivisions which are now dignified by the name of specialties; as, for instance, ophthalmology, otology, gynecology, etc., all of which must still be included under the head of surgery. The oculist or the gynecologist who is not a surgeon, in the largest and best sense of the term, is in great danger of becoming a charlatan. To the introduction of anaesthetics, more than to any other agency, is due the credit of this wonderful extension of the boundaries of modern surgery. It should not be forgotten that this great movement had not only started, but had made considerable progress, before the theories of Pasteur and their practical application to surgery by Joseph Lister were thought of. Perhaps the best illustration of this assertion is derived from the history of abdominal surgery. Spencer Wells, Clay, Atlee, Peaslee, Dunlap and Keith, as well as others, had achieved world-wide fame as ovariotomists long prior to the advent of antiseptic surgery. In his address on surgery to the British Medical Association in 1865, Professor James Syme spoke as follows in reference to the operation of ovariotomy: "The objections originally entertained with regard to both prognosis and diagnosis have been in a great measure removed through the careful discrimination of cases, while the operative procedure has acquired a corresponding degree of perfection, and the results are so satisfactory that the proportion of deaths does not exceed from 30 to 35 per cent. The most successful operator in Scotland is my friend and former house surgeon, Dr. Thomas Keith, who has operated in thirty-five cases and lost only nine of his patients." In the United States and other countries to-day there are many ovariotomists who are honestly of the belief that by the use of strict antiseptics they possess an immense advantage over those ovariotomists of preantiseptic times. They certainly have the unspeakable advantage of the vast accumulations of the recorded experience of operators who, like those whom I have named, have been so careful and thorough in the publication of their cases, their observations and their methods; and still, I ask, can it be truly said that the mortality of ovariotomy has, on the whole, materially lessened since Profes |