If the thorax is opened we see the lobule which is attacked elevated over the surface of the lung, and in some cases particular parts forming projecting vesicles. In longer duration of the process the septa of the aveoli are not spared, and the cavities of the adjacent lobuli blend together. Such lungs go gradually into a system of cavities, in which only strips of the old septa remain.

The old representation, which was also partly accepted by Laennec, sprung from the assumption that this confluence depended upon a tearing of the alveolar walls. This tearing was caused by the increasing pressure on them occasioned by the entrance of the air. Many conditions, however, pronounce against this theory. In the next place, no one has ever seen any form of hemorrhage in connection with such conditions. There is, however, an objection to this, in the fact that one can produce tearing of the alveolar walls by mechanical distension. The air which is driven out through this original hole can not gain entrance into the neighboring alveoli, while in a lung which is in a perfect condition for respiration the alveoli are already filled with air. In this way no union of two kinds of alveoli can occur. We also notice that as soon as a rupture results it is in the form of an interlobular emphysema.

Laennec took the stand that the changes in question were those of the disease, which he has described by the name catarrhe sec (dry catarrh), and he was of the opinion that individuals who had already complained of chronic catarrh had an acute catarrh engrafted thereon. In this connection there is an element which rightly claims a prominent place, viz., the air which comes into the diseased part does not come out again, and also that there is a deficiency in the expiratory passagpes. Laennec did not know, what was afterward made quite clear, that in the general condition of chronic bronchitis a closure of the little bronchi could occur. When this obstruction had a certain duration atalectasis was developed, the exact contrary to what occurs in the disease; the incarcerated air disappears by absorption. When this atalectasis continues longer, then atrophy of this section of the lungs gradually

comes. Emphysema can only originate when a certain part of the air-passages is passable, so that fresh air can always gain admittance.

New observers, who have come nearer to the question experimentally, have failed, because they have sought to prove a narrowing of the principal air-passages, and in consequence a difficulty of expiration. There is, however, no case of emphysema known from the commencement of which there was an accompanying discharge through large sections of the lungs.

If there be really a narrowing of the nasal cavity, or larynx, or large bronchus, as cause of the emphysema, we must also find the entire field of this canal in a similar condition of dilatation. There are enough cases in which there is stenosis of all kinds in the different sections of the respiratory canal, but these are the cases in which emphysema is observed. On the contrary, the larger number of the emphysematous have no change in these principal parts of the respiratory tract.

The contemporary and successor of Laennec, Audral, maintained there was a great number of individuals in whom the appearance of the emphysema could be traced back to a very early youth, and he was inclined to believe that in these cases the tissue of the lung must show what the changes mean. Another consideration was now brought into the discussion of this question, which was rather a hindrance to its solution. Louis in Paris, Audral himself, and later Rokitansky, related a form of emphysema which was connected with a kind of hypertrophy.

He would not deny that such cases indeed occur, but it is seldom, and still more infrequently do they extend over a large surface of the lung. We must acknowledge that the pure emphysema is a condition in which we do not find so much hypertrophy but much more rarefaction (Rokitansky), or a necrobiotic process (Virchow). The tissue melts away, disappears in large sections, leaving no trace. It must fall completely to pieces, and be either expectorated or removed by absorption.

This general emphysema is not a frequent appearance. Prof. Virchow found that the cases in which the clinical diagnosis of emphy

Anatomy, Descriptive and Surgical. By HENRY GRAY, F. R. S. Edited by T. Pickering Pick, Surgeon and Lecturer on Surgery at St. George's Hospital, etc. A new American from the eleventh English edition revised and re-edited by William W. Keen, M. D., Professor of Surgery in the Woman's Medical College of Pennsylvania. To which is added, Landmarks, Medical and Surgical, by Luther Holden, F.R.C.S. Philadelphia: Lea Brothers & Co. 1887. Royal 8vo, pp. 1100; leather. Some weeks past this journal gave notice that the great publishing house of the Lea Brothers & Co. had in press a new edition of Gray. In this notice much was promised in needed additions to the text, additional new plates, and other features worthy of a work which for more than twenty years has had the head of all other text-books in anatomy throughout the civilized world. The finished work comes to hand in such beauty of execution and accuracy of text and illustration as to more than make good the large promise of the prospectus. It would indeed be difficult to name a feature wherein the present American edition of Gray could be mended or bettered, and it needs no prophet to see that the royal work is destined to hold for many years to come the first place among anatomical textbooks. The work is published with black and colored plates. The former, notwithstanding the increased expense of its issue, is sold at the old figures: cloth $6.00, leather $7.00; while the latter which gives in well

contrasted colors the arteries, veins, lymphatics, and features of importance upon viscera and bones, is offered at the small advance of $1.25 upon the prices of the former.

It is a marvel of book-making, and will reward its publishers in a great sale.

Traumatic Hematoma of the Tongue. By Henry Gleitman, M. D. Reprint.

Treatment of Chronic Suppurative Otitis Media. By Seth M. Bishop, M. D. Reprint. Hypertrophy of the Tongue, with History of Cases. By Henry Gleitman, M. D. Reprint.

A Study of Causes and Treatment of Uterine Displacements. By Thomas Addis Emmet, M. D., New York. Reprint.

Statistical Report of 5,700 Cases of Ear Diseases, classified by Age, Sex, Occupation, and Disease Causation. By Seth M. Bishop, M. D. Reprint.

We have received the price list of Eli Lilly & Co., the enterprising Pharmaceutical Chemists of Indianapolis and Kansas City, for January, 1888.

A Practical Treatise on Materia Medica and Therapeutics. By Roberts Bartholow, M. A., M. D., Professor of Materia Medica, General Therapeutics, and Hygiene in Jefferson Medical College, Philadelphia. Sixth edition. 8vo, pp. 802; cloth. New York: D. Appleton & Co. 1887.

The Practice of Medicine and Surgery Applied to the Diseases and Accidents incident to Women. By W. H. Byford, A. M., M. D., lege, and of Obstetrics in the Woman's Medical Professor of Gynecology in Rush Medical ColCollege, etc., and Henry T. Byford, M. D., Surgeon to the Woman's Hospital of Chicago, Gynecologist to St. Luke's Hospital. Fourth edition, thoroughly revised, rewritten, and enlarged by over one hundred pages, with three hundred and six illustrations. 832 pages; cloth, $$5.00; leather, $6.00. Philadelphia: P. Blakiston, Son & Co.

LOUIS C. SCHULMEYER, a druggist who was supposed to have dropped dead from heart disease in a wholesale drug store in Indianapolis, the last week in November, committed suicide by hydrocyanic acid, of which he swallowed nearly an ounce.

Correspondence.

PARIS LETTER.

[FROM OUR SPECIAL CORRESPONDENT.]

In a very interesting lecture on syphilitic affections, Professor Fournier, the eminent syphilographer, expatiated on the differential diagnosis of syphilitic paralysis and that of tabetic paralysis. This latter is known by characters peculiar to itself and by concomitant tabetic symptoms, such as frequent nocturnal emissions, occurring several nights in succession, without any erotic excitement, or difficulty in micturition. In the absence of every other sign of tabes, the paralysis of the muscles of the eye, of tabetic origin, presents special characters. In ordinary paralysis and in syphilitic paralysis the paralysis is total; in paralysis of tabes this paralysis is disassociated. In the fir the paralysis affects nearly always all the branches of the nerve, whence ptosis, external strabismus, immobility of the eye in determined directions, and dilatation of the pupil. In tabes total paralysis is exceptional. More frequently mydriasis exists alone, or at the same time as the paralysis of other muscles of the eye, but the mydriasis always remains the principal symptom. Tabetic paralysis affects more frequently only a small number of muscles, habitually even only one, the rectus internus. In syphilis all the muscles vivified by the common motor ocular nerve are

To account for these differences, Professor Fournier explains them by the localization of lesions producing the two species of paralysis. Syphilis affects the anterior portion of the interpeduncular space at a point where, the nerve being completely constituted, it acts on all the elements of the nervous cord. Tabes localizes itself in the region of the bulb and of the protuberance, at a point where it meets the roots of the nerve still isolated. The lecturer then referred to the sign of Argyl Robertson. In the normal condition the pupil contracts under the influence of a vivid light, to dilate in obscurity; it dilates in looking at dis. tant objects and contracts for near objects.

When paralysis is due to a lesion of the nervous trunk of the third pair, the pupil is dilated and remains insensible to all excitations. In paralysis of the third pair due to tabes the pupil is also dilated, it does not react under the influence of light, but it retains the faculty of dilating and contracting according as the objects looked at are far or near. This sign is expressed thus: the luminous reflex is extinguished, but the accommodation reflex persists. Dr. Fournier considers this sign as almost pathognomonic of tabes. tabes. Another sign, pointed out by this author, of paralysis of a tabetic nature, is the contraction of the pupil or myosis, coinciding with paralysis of other muscles of the eye. The course of paralysis of a syphilitic nature and that of a tabetic nature is not the same: syphilitic is stable and persistent, tabetic paralysis is fugitive and ephemeral, even instantaneous. Syphilitic paralysis relapses rarely, tabetic paralysis frequently. The latter gets well spontaneously, the former is cured only under the influence of appropriate or specific treatment.

Dr. Colleville, in L'Union Medicale du Nordest, vaunts iodoformed vaseline in the proportion of one twentieth, as a useful application to prevent the inconveniences resulting from the marks of smallpox on the face. The author claims the following advantages for the ointment: (1) Often renewed, this ointment maintains a certain degree of coolness on the face which is much appreciated by patients, as they generally feel a burning sensation on it. (2) The attendant pain is calmed by the anesthetic action of the iodoform. (3) It is an antiseptic all ready to disinfect the patient; even the odor of the iodoform, in this proportion, is far from being as disagreeable as that of the pure substance. The odor can, however, be disguised by the addition of some aromatic. (4) The most marked advantage of this ointment consists principally in that it prevents the formation of scabs, the odor from which is ordinarily so penetrating and offensive, for in one or two days, at the latest, the pustules collapse, and there remains no ulterior cicatrix to speak of. Dr. Colleville related a

case of confluent smallpox in which the frequent employment of iodoformed ointment prevented the vesicles from becoming pustules. This a priori would not appear unlikely, if the action so important of this antiseptic in surgical operations be considered. The author has never met with any accidents of intoxication out of ten cases that had come under his observation. To cover

the characteristic odor of iodoform, which is a strong objection to its employment, the Moniteur Therapeutique recommends the addition to it of a few drops of the essence of bitter almonds, or a little tannin, or a little Peruvian balsam. The iodoform should first be emulsified with the ordinary almond oil in equal parts. The addition of any of the substances above named presents no danger whatever. "Morrhuol" is the name given to a special substance extracted from cod-liver oil. This substance is composed of alkaloids which constitute the marvelous curative properties of the oil, and to it is due its anti-bacillary action in tuberculosis. In anticipation of successful results in addition to those already obtained by various physicians, Dr. E. Lachasy, the author of the present note, states that the curative action of cod-liver oil depends on the presence in it of morrhuol, which is its active principle. Owing to the difficulty experienced by physicians to get patients to take cod liver oil, the introduction of this new substance into our armamentarium is looked upon as a great acquisition as a therapeutical agent. Professor Germain Sée, referring to this new substance in his work on clinical medicine makes the following statement: "Cod-liver oil always ends by fatiguing the digestive organs and by saturating the villosities at the end of some weeks. In this case I employ, not without success, a special extract of the oil known by the name of morrhuol. That which is certam is that the remedy is well tolerated and absorbed, and that its anti denutritive action approaches the mod ficative action of the oil." Morrhuol is said to represent twenty-five times its weight of the oil, and has the advantage of combining in a small

volume the medical properties of cod-liver oil without having any of the inconveniences of the latter. It is therefore indicated in all cases in which the oil is considered necessary. To guarantee pills against the action of the gastric juice, Dr. Bernbeck in the Formulaire de Therapeutique, recommends that when they contain principles. which should enter intact into the intestines and which are exposed to be decomposed in the stomach, they should be coated over with a layer of flexible collodium. naphthaline pills, which are unattackable by the gastric juice, but which are rather disagreeable to take owing to the eructations they produce from the stomach, the author has overcome this inconvenience by enveloping them with collodium. With these pills Dr. Bernbeck has generally obtained very good results in the treatment of divers forms of gastro-intestinal catarrh with diarrhea or constipation.

PARIS, December 30, 1887.

LONDON LETTER.

[FROM OUR SPECIAL CORRESPONDENT.]

For

Mr. Gustav Bischof has extended Dr. Koch's method of estimating the number of microscopic organisms in a sample of water in such a way as to show how dangerous it may be to drink water which has been stored in a cistern for several days. Dr. Koch's method was briefly to mix a measured quantity of the water with some sterilized gelatine spread over glass plates for two to three days. Mr. Bischof has prolonged the duration of the test from three days to nine. He finds that the total number of colonies is thus largely increased, particularly in the case of filtered water. Thus, fifteen minims of water which gave 53 colonies in three days yielded 158 colonies in nine days. similar quantity of water taken from the same main and stored for six days, not in an open house cistern liable to all sorts of contamination, but in properly protected vessels, yielded 3,744 colonies of living creatures in the shorter, and no less than 115,344 in the longer period. Such facts ought to bring

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