most of the cases of this epidemic accompanied by complications, especially in the double pneumonias, the eruption was distinctly confluent and the pulmonary mischief arose simultaneously with the rash. This latter statement is, I know, contrary to the generally received opinion on the subject, but I can not, I think, be mistaken as to the fact observed.

When pneumonia occurs in measles, it does not materially differ, except in its duration and fatality, from the affection as seen under other conditions. Its form is in most cases catarrhal, resulting from an extension of the bronchial inflammation. The second most frequent complication in measles is, according to J. Lewis Smith, entero-colitis. Our cases give this place to capillary bronchitis or suffocative catarrh.

I shall allude to the treatment of measles only to say that much the most important part of this consists in watchful care and thorough protection against sudden changes of temperature.

Henoch says patients should be kept in bed for at least one week, and in their room for three weeks in summer, and in winter for a month, even though the disease runs an entirely normal course; no doubt many of the severe and stubborn sequelæ are due to neglect on the part of physician and nurses of these precautions. Affections which complicate measles should have in the main like treatment with that demanded under other circumstances. For the cough, when sufficiently troublesome to require a remedy, J. Lewis Smith's prescription is as good as any:

COCAINE IN TRACHELORRAPHY.

BY A. GASTON ROETH, M. D.

Mrs. M., aged thirty-five; multipara; her last child was delivered with forceps, since which time she has complained of leucorrhea, menorrhagia, and backache. On examination I found a laceration extending from the os externum to the fold of the vagina, on the right side, readily admitting the finger into the cavity of the uterus. As Emmet's operation for the relief of this condition is always performed under ether, I deem it noteworthy to give my individual experience relative to the value of cocaine in its performance.

With twenty minims of a four-per-cent solution of Merk's hydrochlorate I made three hypodermic injections into the cervix, that is, one into each side of the rent, and one at the base of the sulcus. After an interval of five min utes, I painted the surfaces which were to be denuded, and shortly afterward began and completed the operation in the usual manner.

From the moment of the denudation of the hypertrophied surfaces to the insertion of the last wire suture, the patient made no sign of pain. The quantity of the drug used was a little more than half a dram. In future I shall always depend on hydrochlorate of cocaine as a substitute for ether in this operation.

BOSTON, MASS.

LAGOPHTHALMUS.-Dr. Fienzal, in the Bulle tin de la Clinique de l' Hospice des Quinze- Vingts, reports three cases of facial paralysis under the title of paralytic lagophthalmus in diabetes. No history of syphilis or rheumatism could be elicited.

Mr. S. J. Hutchinson, at the November meeting of the Odontological Society of Great Britain, reported a case of lagophthalmus caused by dental irritation. The amalgam plug of a left upper molar was found to rest on the exposed nerve of the tooth. Reflex irritation from this along the branch of the fifth to the third and out to the left levator palpebræ causing constant spasm of that muscle and elevation of the lid. Removal of the tooth resulted in cure.

Reviews and Bibliography.

Transactions of the Academy of Medicine in Ireland. Vol. III, 1885. Fannin & Co., Dublin. Balliere, Tyndall & Cox, London. McClaghan & Stewart, Edinburgh.

This is a handsome volume of nearly five hundred octavo pages. It consists in the main of able papers upon various questions, many of them possessing general interest of a marked character.

Dr. Walter G. Smith, of Dublin, read a paper on lupus and its treatment. Dr. Smith

takes the position that lupus is a tuberculous or scrofulous affection, as proved by the invariable presence of the tubercle bacillus of Koch. Along with corresponding constitutional treatment, he recommends scraping or scarification, according to circumstances of situation, etc., and summarizes and compares the two methods as follows:

Erasion or Scraping (1) Differentiates sound from diseased tissues, for healthy tissue will not give way to the spoon. (2) It is easy of execution. (3) It is, as a rule, not followed by much after-pain. (4) The scraped surface heals wonderfully quick. (5) It leaves a level and tolerably sightly cicatrix.

Scarification (1) Is applicable to some situations, and in some cases where erasion is unsuitable or inadvisable. (2) It is less painful, and, to some persons, a less repellant operation. (3) There is a minimum loss of substance. (4) It is especially adapted for diffuse non-ulcerating infiltrations. (5) The scar left is scarcely distinguishable from the healthy skin, and it is said not to be liable to keloid growths, which sometimes develop on the scars left by scraping operations.

Surgeon-Major Hamilton, of the army medical staff, read a paper on Cholera. Dr. Hamilton describes the home or "manufactory" of cholera in India, a locality from which it is never absent, as embracing the various islands formed by the splitting up of the Ganges and Brahmapootra into innumerable channels as they enter the sea.

These marshy islands are separated by narrow channels, some of them containing fresh and others brackish water, and generally under

the influence of the tide. They have been formed by silt swept down by the rivers, and occupy a territory seventy-five miles wide by one hundred and fifty-eight miles long, or about six thousand five hundred square miles.

From this area epidemics take their rise and extend to the extreme north of India, and under favorable conditions to the rest of Asia and of Europe.

From this point, Dr. Hamilton, following Dr. Bryden, believes that the cholera is taken up by the rain-laden winds and borne north over the epidemic area of India, and that in this spreading the movements of the people have nothing at all to do. That, as far as India is concerned, the cholera is "earth born and wind borne." Cholera in India almost invariably advances up the rivers. As for the comma-bacillus, an investigation made by Kline and Cunningham showed that in numerous cases water was being used by large numbers of people without producing cholera, which yet on examination was found to be full of the microbe in question. As a fallacy of the human-intercourse theory is instanced the fact, that natives from all parts of India gather every year in hundreds of thousands in pilgrimages at Hurdwar, on the Ganges.

Cholera was at this place in 1879, and large numbers of pilgrims died there and in the immediate vicinity. Yet, as they went home, the disease spread only to the northeast, north, and northwest; but to east, south, and southwest there was no spread of the epidemic.

"I believe," says Dr. Hamilton, speaking of quarantine, "that even if commenced in time it has as much power to keep out epidemic cholera as the proverbial pitchfork has to keep back the tide."

and cautious hypodermic injections, but no internal medication.

Finally, Dr. Hamilton says, "I trust I may not be regarded as a pessimist, but I must in conclusion confess that the present outlook, as regards the prevention and treatment of cholera, is dark indeed."

Dr. J. Magee Finney read a paper on Hyperpyrexia in Rheumatic Fever, the main point of which is the advocacy of the treatment of this condition by ice-water packs and cold baths. Dr. Finney has found advantage from salicylic acid and salicylate of soda, but is not able to praise them unqualifyingly, having met with some entire failures in their use.

Dr. Finney enters into a lengthy discussion of the cause of fever heat, but confesses that the subject is in an unsatisfactory condition.

Mr. W. Thornley Stokes contributed a paper on the treatment of stricture by internal urethrotomy, in which he takes the ground that this is destined to drive other methods out of the field, and advocates (1) The superiority of the operation of internal urethrotomy over any form of dilatation. (2) The advantage of the method of Maisonneuve over that of Civiale and his followers. (3) Completeness of division, the disuse of anesthetics, the incision on the upper or pubic-wall, and the non-retention of the catheter in the urethra subsequent to the operation.

Dr. A. H. Jacob read a paper entitled Compulsory Notification a Sham, and shows that in Great Britain as in this country it is impossible to carry out the notification of contagious diseases to the authorities except among the poor and friendless. The rich are almost never reported. Besides, if regular physicians attempt to comply with the law, the complaisant quacks, according to Dr. Jacob, use the bait to their own great advantage by shielding their patients from report. Dr. Jacob claims that the State has no right to compel a physician to report; but whatever the law may be in England, in this country it is clear that a physician might place his refusal on high constitutional grounds. For whoever has rigidly complied with the laws in such cases has found that his property (his good will and confidence) was being taken from him without compensation.

Brain Rest: Being a disquisition on the curative properties of prolonged sleep, by J. LEONARD CORNING, M. D., formerly resident assistant physician to the Hudson River State Hospital for the Insane. Second edition, revised and enlarged, with additional illustrations. 16mo, pp. 135. New York and London: G. P. Putnam's Sons. 1885.

In this monograph the author presents his views of the treatment of those who suffer from insomnia, cerebral exhaustion, and other forms of brain exhaustion.

The first subject that claims attention is the definition and nature of sleep, which the author treats in the usual unsatisfactory way, for a theory of sleep that does not extend to insects and plants can hardly lay claim to having reached the ultimate basis of the subject. The importance of sleep as a remedy for the troubles in question is judiciously enlarged upon. with reference to the various safe and efficient means of accomplishing this object.

A measure for the production of sleep, with which the author's name is more especially connected, is compression of the carotid arteries, and an improved instrument for the purpose is figured in the text. The device is clever, and the theory of its action pretty, but it is safe to predict that such a measure will in practice be rarely if ever employed. rarely if ever employed. It is not likely, however, to do great harm in the hands of the skillful physician.

That opium and chloral should be recommended or given, except where some great emergency demands a night's rest for the patient, or where threatening insanity puts milder measures out of the question, can not be admitted, since the unspeakable miseries which the prolonged use of these drugs brings upon their victims and the readiness with which the habitually sleepless form the opium or chloral habit are facts which contra-indicate their employment in simple insomnia. The author seems to have framed his scheme of treatment for sleepless valetudinarians in large cities or the guarded inmates of the asylum; if this be not so, he

Puerperal Convalescence and the Diseases of the Puerperal Period. By JOSEPH KUCHER, M.D. 16mo, pp. 311. New York: J. H. Vail & Company.

In this monograph the author sets forth the treatment of the lying-in woman in accordance with the antiseptic method as taught by Semmelneis, of Vienna; a method which, though often misapprehended, has become an important factor in the obstetric practice of all civilized lands. The book, while not giving the reader much that is new, is in harmony with the best teachings upon the subject in question. It attains the object of the author, and will do good service in the hands of the practitioner.

D. T. S.

New Yorker Medizinische Presse: Organ der deutsch-americanische Aerzte.

This new journal is a handsome octavo of forty-eight pages, filled with choice original matter, and well-made selections. Its editor is George W. Rachel, M. D. It is the organ of the German-American physicians, and the only medical journal in the German language published in America. We welcome it among our exchanges as a ready means of access to much that is new and valuable in German medical literature. Subscription price, $2.50 per annum. Address, German Medical Press Company, 23 Vanderwater Street, New York.

Venereal Memoranda: A manual for the student and practitioner. By P. A. MORROW, M.D., Clinical Professor of Venereal Diseases in the University of the City of New York, Surgeon to Charity Hospital, etc. 32mo, pp. 332. New York: William Wood & Co. 1885.

The author seeks to give in this little volume a concise exposition of the nature and treatment of venereal diseases, condensing into convenient form the material points embraced in more voluminous works. The book, being altogether practical, will be found useful for ready reference.

D. T. S.

The Cleveland Medical Gazette, a monthly journal of medicine and surgery. A. R. Baker, M. D., editor; S. W. Kelley, M. D., assistant. The second number of the first volume of this We welcome it to our journal is received. sanctum and a place on our list of exchanges.

The Physician's Magazine, Vol. 1, No. 2. Quarterly. Published by Foote & Swift, 1539 Chestnut Street, Philadelphia. Price, $1.00 per annum. This new candidate for professional favor contains a series of well-written articles and book reviews. We accord it with pleasure a place upon our exchange list.

General John Newton, Chief of Engineers, United States Army, originator of the plan and director of the work, has prepared a complete account of the operations for the removal of the obstructions at Hell Gate, from their beginning to the explosion of Flood Rock, in October last, which will appear with full and new illustrations as the leading article in the February number of "The Popular Science Monthly."

A short time before his death, Alexander H. Stephens dictated to his amanuensis a sketch of the late General Lee. The first article was

unsatisfactory, and he began a second. This article, prepared with great care, Mr. Stephens was not able personally to revise, but, as it is, it will appear in the Southern Bivouac for February. A sketch of Lee by Stephens will have a very peculiar interest. The Southern Bivouac for February will contain an article by Judge Gayarré, describing an interview he held in 1866 with William H. Seward relative to the reconstruction of the Southern States.

A Manual of Operative Surgery. By Lewis A. Stimson, B. A., M. D., Surgeon to the Presbyterian and Bellevue Hospitals, Professor of Clinical Surgery in the Medical Faculty of the University of the City of New York, Corresponding Member of the Société de Chirurgie, of Paris. Second edition. With three hundred and forty-two illustrations. 12mo, pp. xxiv and 506. Philadelphia: Lea Brothers & Company. 1885.

Foreign Correspondence.

LONDON LETTER.

[FROM OUR SPECIAL CORRESPONDENT.]

A distinguished medical officer, SurgeonMajor Pringle, who has lately returned from service in Bombay, addressed a meeting, on Saturday, on the subject of State Vaccination. This authority is greatly astonished to find, on his arrival in what is supposed to be a civilized country, inhabited by men of a higher stamp than the Indians among whom his lot had been cast, that any objection to this beneficial safeguard can be held. He has sufficient breadth of mind to understand that some people may dislike compulsory vaccination because it is compulsory vaccination, and that is to say, as an "interference with the liberty of the subject;" but it is difficult to understand the attitude of those who know that their children ought to be vaccinated, and object to it because they must be. As for the benefits derivable from the practice of Jenner's marvelous discovery, Surgeon-Major Pringle seems inclined to deny that vaccination ever fails. Smallpox is occasionally contracted by those who have apparently been vaccinated, but the SurgeonMajor contends that they have, in these cases, merely been subjected to an operation resembling that which is so essential, the failure arising from the use of improper lymph. The testimony of an Indian medical officer is peculiarly valuable, because the most specious argument used by professional anti-vaccinationists is that the decrease of smallpox is due to the general improvement of sanitary conditions. In Indian villages sanitary conditions have not improved. The natives live very much as they always did; but vaccination, properly performed, has effectually suppressed what in former days was a terrible scourge.

Although the report of the royal commission which was appointed to watch and study Dr. Ferran's system of inoculation against cholera is not yet published, the most important of the conclusions arrived at are known; they are as follows: (1) The commission affirms that Dr. Ferrau's system of inoculation can not be considered inoffensive; (2) that the liquid employed

in these inoculations is not properly attenuated; (3) that it is impossible to form a correct judgment of its good effect on account of the various different ways of cultivating the liquid; (4) that the inoculated individual can transmit the cholera to the rest of the inhabitants of a town; (5) that the symptoms presented in the vaccinated persons can not be considered as characteristic symptoms of experimental cholera; (6) that the inoculated individual, by having his physiological equilibrium disturbed

which is what should be mostly avoided in times of epidemics-presents a special tendency to catch all kinds of diseases; (7) that the inoculation gives no immunity against the cholera.

Dr. Bellen, the sanitary commissioner of the Punjaub, India, has written a history of cholera in India, from 1861 to 1882. As the opportunities for the study of this disease are immensely greater there than those which medical men in Europe can enjoy, a work of this kind is worthy of the closest attention of the profession. He agrees with Dr. Chapman and Waters in scouting the cholera-microbe theory, but differs from Dr. Chapman as to the character of the disease. While the latter considers it to be essentially a disease of the nervous system, and that all its symptoms are due to simultaneous and abnormal superabundance of blood in, and excessive activity of, both the spinal cord and the sympathetic nervous centers, Dr. Bellen asserts that it is simply an influenza or catarrh of the mucous membrane of the alimentary canal, precisely analogous to the influenza of the mucous membrane of the respiratory passages. It is satisfactory to find that Dr. Bellen's Indian experience leads him to scout the idea of the communicability of cholera by human intercourse. The work is a specially valuable one at the present moment, for no one could venture to affirm that England will next year escape altogether the attack of the epidemic which has created such ravages in the South of France, Italy, and Spain.

Mr. W. Crookes, F. R. S., and Drs. W. Odling, F. R. S., and Charles M. Tidy, F. C. S., reporting to Colonel Sir Francis Bolton, water examiner for the metropolis, on the composition and quality of daily samples of the water supplied during last month from the mains of the