Insanity and its Treatment. Lectures on the Treatment, Medical and Legal, of Insane Patients. By G. FIELDIng Blandford, M. D. (Oxon.) Fellow of the Royal College of Physicians, London, etc. Third edition. Together with Types of Insanity, an illustrated guide in the physical diagnosis of mental disease, by ALLAN MCCLANE HAMILTON, M.D., one of the Consulting Physicians to the Insane Asylums of New York. 8vo, pp. 379. New York: Wm. Wood & Co. 1886. February volume of Wood's Library of Standard Authors.

This volume is an elaboration of the lectures delivered at the School of St. George's Hospital, and presented in lecture form; a fact which, while it detracts somewhat from the completeness of the treatise, yet renders it all the more attractive reading. It is marked by a clearness of conception and a definite grasp that does not belong to all recent works on this intricate and difficult subject.

The article on feigned insanity is one that can not fail to profit the general reader, while the chapters upon the law of lunacy and the examination of patients can not but be very helpful to those who may have official dealings with matters pertaining to the insane. True, the legal forms and steps are those peculiar to English law, which perhaps are not exactly applicable to any of our States; but they are so thorough, and every point so well guarded, that they can not fail in any case to be instructive and suggestive.

The additions by Dr. Hamilton, on Types of Insanity, are especially valuable.

D. T. S.

Diseases of the Spinal Cord. By BYROM BRAMWELL, M. D., F. R. C. P. (Edin.) Second edition. 8vo, pp. 298. New York: Wm. Wood & Co. 1886.

This, the first volume of Wood's Library of Standard Medical Authors for 1886, is one of the many excellent works now being given out

Guide to the Examination of Urine, with special reference to the Diseases of the Urinary Apparatus. By K. B. HOFFMAN and R. ULTZMANN. Second edition. Translated and edited by F. FORCHEIMER, M. D., Professor of Physiology at the Medical College of Ohio. With illustrations. 12mo, pp. 251; price, $1.50. Cincinnati: Woodruff & Co., publishers. 1886.

The work before us, the production of two eminent physiological chemists, in this revised edition affords every thing that is needed by student or practitioner who desires such a knowledge of urinary analysis and tests as will answer for all practical purposes.

The book is not intended for the physiological chemist, nor for one designing to make animal chemistry a specialty. But every point of practical interest is clearly and succinctly treated, and every test and every method brought home to the student and physician in practice in a way easily understood and applied.

The adoption of the original as a text-book by the German high schools has been almost universal, and in our own land it can not but contribute greatly to extending a general knowledge of a subject about which no physician with any claim to scientific attainments can now afford to be unadvised.

D. T. S.

Transactions of the Medical Society of the State of West Virginia. Nineteenth annual session, held at Charleston, May 19, 20, 1886.

The Refraction and Accommodation of the Eye and their Anomalies. By E. Landolt, M. D., Paris. Translated under the author's supervision, C. M. Culver, M. A., M. D., of Albany, N. Y. With one hundred and forty illustrations. 8vo, pp. 600. Philadelphia: J. B. Lippincott & Co. 1886.

Hard Chancre of the Eyelids in Conjunctiva. By David Beck, M. D., Assistant to the Chair of Ophthalmology. Cincinnati: Press of Robert Clark & Co. 1886.

Papillom, am 5, Luftröhrenknorpel auf laryngoscopischem wege entfernt. Von C. Labus, aus Mailand separat abdruck aus der Monatschrift für Ohrenhulkunde. 1886.

Medicine of the Future. An address prepared for the annual meeting of the British Medical Association in 1886. By Austin Flint (sen.), M. D., LL. D. 12mo, pp. 37. New York: D. Appleton & Co. 1886.

Homeopathy as viewed by a Member of the Massachusetts Medical Society. An address delivered April 15, 1866, before the Hahnemann Society of the Boston University School of Medicine. By Vincent Bowditch, A. B., M.D. (Harv.). Reprint from Boston Medical and Surgical Journal.

Foreign Correspondence.

PARIS LETTER.

[FROM OUR SPECIAL CORRESPONDENT.]

The occupying of mountain heights, whether temporarily or permanently, as a therapeutic measure, has become a question of such importance that I thought a note lately communicated to the Société Française d'Hygiene, by Dr. Deligny, on the action of the air of certain altitudes on pulmonary hemorrhage, would be acceptable to the AMERICAN PRACTITIONER AND NEWS.

Prof. Lombard, of Geneva, has brought to notice the fact that, in phthisical subjects, hemorrhage is more rare at a certain altitude than on the plains. The same fact was noticed by Brehmer, Weber, Kuchenmeister; and Prof. Jaccoud, in his clinical lessons, has laid down as a principle that hemoptysis, or a tendency to it, is favorably influenced by occupying certain altitudes, and that they are in these cases of some utility.

In the following lines an attempt is made to explain the known action of mountain air. From a height of about two thousand feet to three thousand feet, the higher one ascends, the more the air of the mountains modifies the functions of the circulation and of respiration, which is the consequence of the diminu

tion of atmospheric pressure, the lowering of the temperature, and also of other factors which are of less importance. Upon the side of the respiration there is an augmentation of the pulmonary capacity and an enlargement of the thoracic cage, as well as acceleration of the respiratory movements. The respiration is more ample, the inspirations are more profound; in short, the entire lungs fully perform their function. This circumstance has been adduced to explain the immunity from phthisis which the inhabitants of mountains enjoy. On the side of the circulation there is, as a first phenomenon, an acceleration of the beats of the heart, followed by an afflux of blood to the periphery, turgescence of the cutaneous capillaries indicated by a more intense coloration of the mucous membranes, as may be seen in that of the mouth and of the tongue. From this cutaneous congestion and the afflux of blood to the periphery result, according to Prof. Jaccoud, an anemia of the viscera, which, however, is relative and slight, and is marked by symptoms rather favorable than otherwise; the cerebro-spinal functions are more active, more easily performed; the respiration is easier, the power of locomotion is increased. The lungs participate in this anemia of the viscera, and the circulation of the organ is thus relieved, the tendency to pulmonary congestion is less, and even the pre-existing congestion disappears. This excitement of the cutaneous circulation is sometimes very marked. In subjects predisposed to congestion of the face, and in the obese, it is often exaggerated; the capillaries are turgescent, congested eyes become more injected; and if the circulation is still more excited by the muscular work necessitated by walking on the mountains, it is not rare to witness, even at medium altitudes, hemorrhages from the nose, eyes, and even from the ears. The obese, especially those who are the subjects of an atheromatous condition of the arteries, ought to avoid ascending the mountains, as it might determine accidents. which would prove fatal. The diminution of atmospheric pressure and the low temperature combine to determine an incessant rush of blood toward the skin.

This action of the air of high altitudes on

It has been asserted that a sojourn in a brisk and cold air facilitates pulmonary congestion. This is perfectly true for the cold and damp air of the plains, remarks the author of the paper under notice; but the contrary is observed for altitudes, the air of which is cold and brisk, but remarkably dry. To insure the antihemoptoic action of the air of great altitudes, certain conditions are necessary before any appreciable effects can be produced. In the first place, the altitude appropriate to individual cases must be taken into consideration. Prof. Lombard divides mountain climates into two categories: (1) Climates that are more sedative than tonic, which may be found at an altitude of from about two thousand feet to about three thousand feet. (2) Those that are more tonic than sedative, at an altitude above three thousand feet.

The next condition necessary is acclimatation, or, what Prof. Jaccoud terms, "accoutumance," the period of which should depend on circumstances, and invalids should never be removed direct from the plains to the higher regions, but this should be done by stages before they proceed to the highest point prescribed above, in order to avoid the risks already referred to. Acclimatation is therefore, according to Prof. Jaccoud, an important element in the application of climatic therapeutics of altitudes.

As regards pulmonary hemorrhage, the same author considers that a residence on mountain heights has a favorable action in these cases, but only in bearing in mind the conditions indicated. But while mountain air is favorable to pulmonary hemorrhage, it would be injurious in hemorrhages from the intestines, the stomach, and the uterus.

At a recent meeting of the Surgical Society of Paris, Dr. Terrier read a very interesting paper on the Influence of Ovariotomy on Menstruation. The author gives the results of two series of cases, one in which the ablation of both ovaries was performed at the same sitting, and in another where the second ovary was removed some time after the first. In the former group menstruation ceased altogether

having menstruated more or less regularly prior to the operation. In the second group, where the ablation was consecutive, the result was almost similar. In one case menstruation had returned after the first operation, but disappeared after the second; in another it returned two months after the second operation, but was followed by its suppression altogether. In three other cases menstruation recurred in one at intervals of six months; in a second, four times in three years; and in a third, five times in eighteen months, when it became monthly.

From these observations the author draws the following conclusions: Removal of both ovaries leads to suppression of the menses, but this may not be immediate, in consequence of the persistence of the habit of periodical congestion of the uterus and its annexes. He entertains certain doubts as to whether the total ablation of the ovaries was really affected in those cases where the menses reappeared after operation.

PARIS, June 25, 1886.

LONDON LETTER.

[FROM OUR SPECIAL CORRESPONDENT.]

The unveiling of the Queen's statue of John Hunter, at Oxford, by Princess Christian, and the address which was delivered on that occasion by Sir James Paget, recall to mind the services done to science by a man whose name is but little known to the rising generation. Grateful as scientific men may always be to the memory of Hunter, there is no denying the fact that, save those interested in the history of research are able to realize what that great man did for knowledge at a time when the means of research were limited in number, and when substantial encouragement to original work was practically unknown, all possess some dim idea that John Hunter was concerned in the establishment of the great museum of the College of Surgeons in Lincoln's-inn-fields, which forms not merely the crowning glory of English medicine in the way of anatomical collections, but stands unrivaled throughout the world as an educative

display. To Hunter belongs the everlasting credit of establishing the museum which bears his name. One reads with admiration of his search after rare men and beasts, that he might anatomize and preserve their skeletons and soft parts for educational purposes. Now it was a tiger which had died in a menagerie; now it was the body of some human giant or other, like Patrick Byrne, whose relatives insisted upon burial, but whose anatomy Hunter, by hook or by crook, had determined should figure in his collection of curiosities. Then it was some queer abnormality in the way of animal growth which attracted his indefatigable soul, eager in his quest after that knowledge which was to lessen pain, to save life, and to improve at large what Bacon calls the estate of man. His perseverance was equaled only by his reverence for even the smallest and apparently the most trivial facts. Like Darwin himself, John Hunter despised no detail of nature, however feeble or seemingly unimportant it might be. Sir James Paget himself illustrates this trait of Hunter's character by a very quaint example. He is writing to Jenner, of vaccination fame, an old pupil. "Dear Jenner," he writes, "you must think me very fond of fish when you even send me cheese as much fishifyed as possible." From which it would appear that Jenner had been transmitting to London some of the choicest products of Gloucestershire. Then continues the epistle, "However, it is an excellent cheese, and every country has laid claim to its birth." Here ends the cheese, but the anatomist at once comes to the front. Cheese may be all very well as a dainty, but business ranks before pleasure. "I have but one order to send you," writes Hunter," which is, send every thing you can get, whether animal, vegetable, or mineral, and the compound of the two, namely, animal and vegetable mineralized." He was on the quest after fossils, as Sir James Paget remarks; and Owen himself has testified to some literally marvelous forecasts in Hunter's writings of modern discoveries regarding the petrifactions of rocks. So it was with many other facts of nature. John Hunter labored for knowledge, not for fee or reward. Whether he is demonstrating how horns can be grafted

on a cock's head, or how bone grows, and how wonderful things in the way of repair of injuries can be done by nature unaided, he is ever the same diligent truth-seeker. Darwin is known better, for he was a great and grand figure of the present day. John Hunter, however, must not be allowed to become a mere shadowy figure.

The practical utility of knowledge was not overlooked by John Hunter in his search after the wonders of nature. He was a surgeon far in advance of his generation in all matters pertaining to his profession. There was a case of apparently malignant growth affecting a lad, about whom Jenner wrote to his master. In reply Hunter, whose language was always plain and occasionally forcible, advises Jenner to have patience. "I would have you do nothing with the boy," he writes, "but dress him (i. e. his ailment) superficially; these funguses will die and be damned to them, and drop off." This, no doubt, was sound advice, and one can forgive the liberty of the expletive when one remembers that a century ago men were not quite so careful in their selection of phraseology as they are to-day. There are certain experiments of Hunter's which are immortal in the sense that they were epochmaking in the treatment of diseases, which, before his day, were regarded as essentially of a fatal nature. For instance, the treatment of aneurism. of aneurism. An apparently hopeless case of this ailment had been placed under Hunter's care. It affected the femoral artery, and the only resource in those days was amputation of the limb. But Hunter had previously experimented upon the growth of antlers in the deer of Richmond Park, a privilege which had been granted him by the king. One of the vessels supplying the growing antler with nutrition. had been tied. The nutritive supply being cut off, the antler became cold and was apparently ready to die. In a week or two Hunter, to his astonishment, beheld the horn growing warm as if its vitality was returning. Growth was actually resumed, and on examination the fact of the establishment of a collateral circulation was discovered. Applying this fact to the cure of aneurism, Hunter's clear mind grasped the idea of utilizing it in

the cure of the diseases of humanity, and in the saving of life and limb. He operated with singular success, and his treatment of aneurism is the treatment of to-day. His fourth patient lived for fifty years after the operation suggested by the antlers of the stag, and appropriately enough the specimen illustrating the case finds a place on the shelves of the museum in Lincoln's-inn-fields.

In the letter to Jenner, from which a quotation has been above given, after his abjuration to the "fungus," as he writes it, Hunter at once goes off at a tangent on his eager search after knowledge. "Have you any trees of different kinds that you can make free with?" he inquires of the Gloucestershire practitioner; "If you have," continues Hunter, "I will put you upon a set of experiments with regard to the heat of vegetables." There is another query bearing also upon the heat question in the shape of the remark, "Have you any caves where bats go to at night?" The "bats" were to form subjects of yet another research into the causes of heat.

The Queen's gift of John Hunter's statue to Oxford University is a graceful act, which will shine forth amidst many other favors of like kind. Whoever may be forgotten in the rush of modern life and toil, it behooves us, out of gratitude "for favors received" in many departments of knowledge, to keep John Hunter's memory green.

Sir William Jenner has been for the sixth time elected president of the Royal College of Physicians.

LONDON, June, 1886.

Ar the recent meeting of the Association of American Physicians, held in Washington, the following officers were chosen for the ensuing year: Drs. S. Weir Mitchell, President; Francis Minot, First Vice-President; R. P. Howard, Second Vice-President; G. L. Peabody, Secretary; J. T. Whittaker, Recorder. A Council of seven members was also chosen: Drs. W. H. Draper, of New York; R. T. Edes, of Boston; H. M. Lyman, of Chicago; S. C. Busey, of Washington; F. C. Shattuck, of Boston; W. H. Welch, of Baltimore; William Osler, of Philadelphia.

Translations.

FRACTURE OF THE PENIS.-An able-bodied laborer, twenty-seven years old, in May, 1885, attempting to micturate with a strongly erected penis, pressed it downward with force for the purpose. He experienced at once a severe, sudden pain, and felt that something had broken. Ten hours afterward he was taken to the hospital and found in the following condition: The penis had a truly monstrous size and shape, was enormously swollen. and edematous, bluish - black, and looked not unlike a smoked blood-sausage. The length was five inches and the diameter about the same; the discoloration extended to the scrotum and the perineum. The prepuce was so swollen and the penis had so twisted upon its axis that it was with the greatest difficulty that the urethral orifice could be found. By closer examination the fracture was located about half an inch from the root of the penis. Treatment with cataplasms, together with local application of gray ointment, led to speedy alleviation of the great pain, and by the 20th of June the fracture appeared to be healed, though some thickening could be distinctly felt. For a time the occurrence of erections was very painful, but the intensity of the pain gradually abated, and since December he accomplishes coitus "easily and with pleasure." El Siglo. Medico. (Jan. 31, 1886.)

ETIOLOGY OF ALOPECIA AREATA.-Dr. Max Joseph, of Berlin, has succeeded in producing scattered areas of baldness about the head of cats and puppies, very closely resembling alopecia areata, by severing the second cervical

nerve.

The baldness came on in from five to fifteen days after cutting the nerve, and took the form of round or oval spots half an inch in diameter, which gradually spread to embrace the entire part supplied by the nerve. This result, the author thinks, points clearly to alopecia areata as a result of the impairment or destruction of the innervation derived from the trophic nerves of the skin.-Deutsche Med. Zeitung.