toneum show thickening or other inflammatory signs.

31. Examine and remove the spleen first, its size, shape, color, and density, and the appearance of the capsule. An incision parallel to its flat surface will expose the follicles, trabeculae, and pulp.

32. Examine omentum and small and large intestines in rotation, and note any injury or pathological peculiarities they may present inside or outside. The duodenum should be examined in situ by an incision made with the scissors on the outer border in cases of jaundice causing death.

33. The stomach and the pancreas should be removed next, and the kidneys, ureters, and bladder viewed in situ, after which, if necessary, they also may be removed.

34. In females the next step is, remove the genital organs and examine.

35. The liver should now be removed and

Water: Its Impurities, gathered from the Air and Earth; the Organisms that grow in By C. W. Moore, M. D., San Francisco. Reit, and the Modern Methods of Purification. print.

Effects of Food Preservation on the Action of Diastase, Pancreatic Extract, and Pepsin. By Henry Leffmann, M. D., and William Beam, M. A. Pamphlet, pp. 9.

The Relation of Alimentation and Disease. By J. H. Salisbury, A. M., M. D., LL. D., Member of the Philosophical Society of Great Britain, etc. 8vo, pp. 332; cloth. New York: J. H. Vail & Co. 1888.

Intubation of the Larynx. By F. E. Waxham, M. D., Professor of Otology, Rhinology, and Laryngology, College of Physicians and Surgeons, Chicago. 12mo, pp. 110; cloth. Chicago: Charles Truax.

A New Method in the Treatment of the Vegetable Parasitic Diseases of the Skin. By Henry J. Reynolds, M. D., of Chicago. Read before the Section on Dermatology Ninth International Medical Congress. Pam

Disorders of Menstruation. By Edward W. Jenks, M. D., LL. D., Professor of Gynecology in the Michigan College of Medicine and Surgery, etc. Physicians' Leisure Library. Paper, 25 cents; cloth, 50 cents. Detroit: George S. Davis. 1888.

Medical Publications: Harvard Medical School, 1887. Preface: "The following articles are presented in bound form to show the character of the original work done by the instructors of the school, or under their personal supervision, during the year. It was not thought desirable to include clinical papers in this collection. A portion only of the work of the year 1887 is represented by these publications." J. Collins Warren, Chairman of the Committee on Publication, Boston, Mass.

A System of Obstetrics by American Authors. Edited by Barton Cooke Hirst, M. D., Associate Professor of Obstetrics in the Volume University of Pennsylvania, etc.

I. Illustrated with a colored plate and three hundred and nine engravings on wood. Contributors to Volume I: Samuel C. Busey, M. D.; George J. Englemann, M. D.; Barton Cooke Hirst, M. D.; William Wright Jaggard, A. M., M. D.; H. Newell Martin, M. D., D. Sc., M. A.; Theophilus Parvin, M. D., LL. D.; R. A. F. Penrose, M. D., LL. D.; J. C. Reeve, M. D. 8vo, pp. 808; leather. Philadelphia: Lea Brothers & Co. 1888.

The Applied Anatomy of the Nervous System, being a study of this portion of the human body from a stand-point of its general interest and practical utility on diag nosis, designed for use as a text-book and a work of reference. By Ambrose L. Ranney, A. M., M. D., Professor of Anatomy and Physiology of the Nervous System in the New York Post-graduate Medical School and Hospital. Second edition. 8vo, pp. XXXV-791; cloth. New York: D. Appleton & Co. 1888.

The Pathology, Diagnosis, and Treatment of Diseases of Women. By Grailly Hewitt, M. D., London, F. R. C. P., Professor of Midwifery and Diseases of Women, University College, and Qbstetric Physician to the Hospital. A new American from the fourth London edition, with two hundred and thirty-six illustrations. Edited, with notes and additions, by H. Marion - Sims, M. D., New York; Vols. 1, 2, and 3. 12mo, cloth. Price per vol., $2.75. New York: E. B. Treat. 1887.

Correspondence.

PARIS LETTER.

[FROM OUR SPECIAL CORRESPONDENT.]

Dr. H. Verrier, formerly externe of Professor Broca, in his inaugural thesis (1879) treated of asphasia in general paralysis. He has since extended the subject to other analogous conditions, and has at the same time touched on cerebral localizations, in which he embraced a summary of the fourth conference on transformism, held at the Anthropological Society of Paris, in December last. In this summary was also embodied a paper by Professor Mathias Duval and extracts from the works of Professor Charcot. Setting aside cases of mental alienation, M. Duval recognizes four principal types of aphasia, in which by the aid of rigorous observations, the greater part being made at autopsies, he has been enabled to determine the exact part of the brain affected by the producing lesion of aphasia and other analogous conditions.

First Type. left temporal convolution. There is in this case loss of auditive verbal memory, or verbal deafness. M. Duval observed that in left

The lesion bears on the first

handed persons, according to the explanation given by Broca, the pathological lesion would be found on the right side.

Second Type. The lesion bears on the second left parietal convolution. In this case there is loss of visual verbal memory, or verbal cecity. The same explanation of Broca applies to left-handed persons.

Third Type. The lesion bears on the lower portion of the second frontal convolution, and the patient has lost the motor graphic memory. In this case there is aphasia of the hand, agraphia. Dr. Ballet, in his thesis on Interior Language (1886), had perfectly established, independent of autopsies, the exact seat of this variety of aphasia.

Fourth Type. The lesion bears on the posterior half of the left third frontal convolution. This is the aphasia of Broca, known by pathologists, and even by the intelligent portion of the lay public. In this case there is loss of motor verbal memory or verbal aphasia.

M. Duval deduces from this division that there are different sorts of memory, and that this faculty is found distributed in several parts of the encephalon, viz: two at the back of the fissure of Rolando, these are the visual and auditive memories; and two in front of this fissure, these are the graphic and verbal memories; the first are sensitive, the second motor. A palpable proof, which corroborates the discovery of Broca relative to the seat of speech in the posterior half of the left third frontal convolution in righthanded persons. This was the state of the brain of Gambetta, in which this convolution was so developed that the part designated by Broca under the name of "cape," was really double. On the contrary, on the brain of a man not less intelligent than Gambetta, but who, far from being an orator, had some difficulty in expressing his thoughts, the same convolution scarcely attained the average of development which it presents in any ordinary person. The man referred to was the late Dr. Bertillon, the celebrated anthropologist, and Director of the Statistical Department at the Prefecture of the Seine.

M. Duval concluded his paper with the following remarks: "These studies of comparative cerebral pathology may not only give hope of a cure by a progressive adaptation to the functions of the brain of the opposite part of the healthy hemisphere, but has given the author the extraordinary idea of engaging his hearers to inscribe their names as members of the 'Societe d' Autopsie Mutuelle,' alleging as his reason for the recommendation that, knowing during life the aptitudes of each other, it would be easy after death to verify on the presumed corresponding parts of the brain the material impressions produced by these aptitudes. This would furnish a means for the study of cerebral localizations very different and more certain than that of the phrenology of Gall and Spurzheim."

Dr. Crozes, of Algiers, extols the application of blisters in Jacksonian epilepsy. He writes, in the Journal de Médecine, that, applied above the seat of the aura, blisters might produce a complete and definitive cure in the majority of cases, while in others there is only an amelioration, but which is manifest. Even when they do not cure or improve, blisters produce notable modifica tions in the symptomatic characters of the attack. Among the phenomena observed in this case, that which strikes one the most is the phenomenon of the transfer of the aura, which may manifest itself on the member of the same side, on the corresponding member of the opposite, or on several members at the same time. One may even see the transfer of the post-epileptic paralysis produced in the members of the opposite side. The author would recommend the application of blisters even in all cases of partial epilepsy with motor peripheric aura. The blisters should be applied on a level with or above. the starting point of the aura, and fresh revulsives should be applied in the neighborhood of the parts where the aura will make its appearance.

Dr. Potain, Physician to the Necker Hospital, has introduced a new method of treating pleuritic effusions consecutive to pneumothorax, by intra-pleural injections of steril

ized air. Arguing that the sudden abstraction of the totality of the liquid, or its removal in several days, may be attended with grave inconveniences, he decided upon replacing the liquid according as it flowed from the body by a substance less hurtful, by sterilized air; and it was thus that, after four punctures made in the space of five months, he was able to cure a patient in bis ward, not only of his pneumo-thorax and his pleuritic effusion, but also his tuberculosis. This was verified by the examination of the sputa and the liquid of the pleura, both of which at first contained numerous tubercu lous bacilli, but none were to be found after the above treatment. Two other cases were treated in a similar manner, which proved equally successful. These cases were reported by Dr. Potain at a recent meeting of the Academy of Medicine, when he exhib ited the instruments he had employed, and explained the technic of the operation. The author insisted on the observation of two

principles which should never be neglected. In the first place it is rigorous antisepsis, in the next, the necessity for not suddenly producing great variations of pressure in the pleural cavity. On the other hand, in leav ing for a long time the lungs in a state of inaction, a definitive cure of the tuberculous lesions is effected.

As anticipated, saccharin is gradually finding its way in commerce, not only as a substitute for sugar, but the latter is now being adulterated with it, and thus largely employed in the manufacture of various foods and drinks. A test to detect the pres ence of this drug in any other substance is very desirable. The Formulaire Mensuel de Therapeutique writes that the solubility of saccharin in ether may be utilized with advantage for the research of this product. As it is employed in only very small quantity, one must operate on a notable proportion of the substance to be examined, for instance, on one hundred grams of sugar. The latter should be mixed in a vial with one hundred and fifty or two hundred cubic centimeters of ether, and should be shaken at intervals during some hours. The ether is to be with

drawn by distillation, and a search for the saccharin is made in the residue of the evaporation. If the sample of sugar presents an alkaline reaction, this is dissolved and slightly acidulated with phosphoric acid before adding the ether. The saccharin contains sulphur; pure carbonate and nitrate of soda are added to the residue of the evaporation of the ether, which is gradually heated in a platinum crucible. If, in the result of this treatment, one finds traces of sulphuric acid, the presence of saccharin may be surely deduced.

PARIS, June, 1888.

Abstracts and Selections.

ON CARCINOMA OF THE BREAST AND ITS TREATMENT. - An old St. Bartholomew's man naturally thinks of what his old teacher, Paget, has written and said on the subject; and I have found, since I thought of writing this paper, much that was interesting and instructive in the retrospect that I have been able to make. In those brilliant lectures on surgical pathology, which will hand his name down with Syme and Simpson to the end of time, amidst much that is clear and certain, and which forty years of active research has not impugned, we find the successful pathologist penning at the end of his lectures an eloquent but touching sentence in which he acknowledges his inability to explain the causation and growths of cancer, where he seeks for its explanation in an appeal from the visible to the invisible, from this world to that which is to come. From this work he passed in a year or two to the active and successful practice of the profession; and it is well known that he had a larger experience than falls to most men in his favorite pursuit; and toward the end of his great professional activity in the famous discussion on cancer at the Pathological Society we read his eloquent, his clear, outspoken exposition of his views, showing that the practical work in which he had been engaged had made him more hopeful as to the future treatment of cancer, and more encouraging to those who had followed him in his pathological career, still insisting, however, on its constitutional nature. A few years later, in that brilliant and charming lecture delivered at Cambridge, on "Elemental Pathology," returning as a veteran with practical expe

rience to his old pursuit, he drew a likeness between the galls of the oak and cancerous growth, helping to lay the foundations of a comparative pathology, and leaving it as a legacy to his successors in pathological research to utilize for the benefit of succeeding generations.

In that lecture he foreshadowed in no uncertain terms the opinion which in the Morton Lecture, in 1887, he declared with no doubtful sound, viz., that cancer is not a local disease, that it is constitutional, probably specific in its origin, and that while we are justified in using the knife in the removal of a dangerous and external manifestation of the disease, still we are bound to search for and find a cure for the specific mischief just as surely as we do in other specific diseases. His concluding words are pregnant with meaning in these days of Banks and Gross, and I will venture to quote them.

"If once the specific morbid material can be found, it may be dealt with, as thus generally like, but specifically unlike, it may have been. But I will not guess how I have tried to show by facts a right way to a good end. I will not now by guesses run the risk of pointing to a wrong one. Gross, in a recent paper on "Mammary Cancer, mentions Paget as the only pathologist left who does not believe in the local origin of cancer. I think that is rather a sweeping statement; but even if it were true, I think there must still be a large army of practical surgeons who would follow him in his opinion.

The local or constitutional origin of carcinoma of the breast is a matter of more especial importance just now, as it involves the question of treatment, and at a future meeting I think there are many points which might afford matter for a useful discussion. We have yet to learn the connection between cancer and syphilis, the meaning of burns and ulcers taking on malignant characters, the parts that inheritance, wealth, and work, and luxury play in its growth, as well as the frequent invasion of undeveloped and misplaced organs. But we have not time for that to-night, I want to bring the more urgent question of the kind of operation which we are bound to recommend and perform. Excluding those cases, which are admitted by all to be unfit for operation, in which there are adhesions to the chest wall, in which there are internal complications, or when the patient is manifestly in a condition rendering an operation impossible, excluding, I say, these cases, I do not suppose there

is any one now who will deny that the removal of a breast for a cancer prolongs life and promotes mental and bodily comfort for a longer or shorter period.

But there is a wide difference of opinion as to the mode of operation. There is, firstly, the old operation, the removal of the breast, and only such axillary glands as we may feel at the time of operation are enlarged or indurated; and there is, secondly, the more formidable operation, as urged by Banks, Gross, Edmund Owen, and Esmarch. The operation means, according to Banks, the removal of all axillary glands as an invarible accompaniment of removal of the breast; according to Gross a much wider removal of integument, and a more complete clearing away of fat and of the contents of the axilla; according to Owen, the removal of the supraclavicular glands; and according to Esmarch, in some cases the removal of the upper extremity at the shoulder-joint. They all admit frankly enough that this is an operation which carries with it an enormously increased mortality as the immediate result of the operation, and I think we shall have no difficulty in believing that it is so. The question is whether it is justifiable to run the increased risk, from a careful comparison of the results of the earlier with the results of the newer operation. Butlin, whose book I have looked at since I wrote the greater part of this paper, shows that the mortality of the second is more than twice that of the first method of operation.

There is no doubt that the immediate mortality of the operation is very great; in fact, that the operation must be considered to be one of the most dangerous in surgery: and that the patient must be told so; but in telling the patient this, what further can one conscientiously tell her to justify her undergoing this enormous risk (8 per cent for the ordinary, and all but 23 per cent for the extraordinary operation). Can we tell her that she will be cured? Gross considers that a patient is safe from reproduction if three years have elapsed since the operation without its appearance. I think that this is a rash assertion, which he can not prove. From a large number of cases taken from the various European and American hospitals he appears to disprove his own case, and if I have read his statistics, excluding those taken from his own practice, correctly, not only by the more serious operation is the death-rate enormously increased, but the return of the disease is clearly more rapid. Further, he seems to assume that there is nearly always a return of the disease in the

axillary glands when they are left behind. Surely this is not the experience of those who operate in the ordinary way. So far as recurrence in the breast and axilla is concerned, various conclusions have been arrived at. Butlin thinks these parts escape to the extent of from twelve to fifteen per cent, and I am inclined to think that he is under rather than over the average results, and the experience of many surgeons is better than those taken from European hospitals, where the more formidable operation has been most frequently adopted. Further, these axillary glands, which we know are difficult to remove without endangering life; this removal of two inches of the axillary veins; the stretching of nerves; what is it all for? To prevent the recurrence of the disease in them, which occurs in some three per cent of our cases, and which has occurred in a greater number when the axilla has been completely cleared out. In fact, to add to the dangers of the operation we have to add the more rapid recurrence of the mischief.

It is no good wearying you with more statistics; by the new operation it is admitted that the mortality from the operation is largely increased; that the cases of cure are not all to be put down to the entire clearance of glands from the axilla, as they occur where no such clearance has taken place; that recurrence is not really deferred by such a clearance; but so far as the large continental hospitals are concerned is rather expedited, and it becomes a very serious question whether we have not made a retrograde step by raising the death-rate of a hitherto not very dangerous operation without any thing to show for it, and when we knew that anatomically the object we had in view was unattainable. Butlin says: "And I entirely disapprove of this wholesale method of treating cancer of the breast, and believe it to be unscientific and needlessly cruel to many women. I shall venture to criticise it as thoroughly as I can do. on the evidence which is before me."—Arthur Jackson, M. R. C. S., London Medical Press.

THE SIGNIFICANCE OF BLOOD PRESSURE IN RENAL DISEASE.-While I thoroughly appreciate and agree with the whole tone of Dr. Broadbent's remarks on the significance of the blood pressure in acute renal disease, I feel that on one point I must differ from him. After well describing the course of the variations of tension usual in that disease, he points out, what is certainly true, the failure to develop increased tension gen