mold which alone renders the production of food possible, how they purify the water we drink and even the air we breathe, and who are unable to work ourselves up into a decent fight at the thought that a few of the many are unfriendly, ought to feel thankful to the enthusiastic leaders who are willing to burden themselves with the apprehensions in which we are deficient.

Another point, which is too often neglected. by hygienists, and also by political economists, viz., the employment of sewage for the renovation of the soil, comes in for a share of attention.

The present dread of microbes and their ravages may not be excessive, but one can not banish the thought that at the present rate of the increase of population largely due to the work of sanitarians, and the present rate of exhaustion of the fertility of the soil, the time must come in the not far distant future when hungry multitudes will be profuse with regrets that hygienists did not permit their great grandmothers to be carried off in their early teens by inimical microbes.

D. T. S.

Food in Health and Disease. By J. BURNEY YEO, M. D., F. R. C. P. 583 pp. Price, $200. Philadelphia: Lea Brothers & Co.

The announcement of the fact that a work on dietetics had appeared under the authorship of Dr. Yeo would carry with it the presumption that

an excellent treatise had been added to the literature of the subject. "Food in Health and Disease" fully justifies the presumption. The author not only gives us here the fruits of his own mature and careful studies, but he likewise gleans with a discriminating hand all that

Essentials of Gynecology. Arranged in the form of Questions and Answers, prepared especially for Students of Medicine. By EDWIN B. CRAGIN, M. D. With fifty-eight illustrations. 192 pp. Price, cloth, $1.00; interleaved for taking notes, $1.25.

This constitutes No. 10 of Saunders' Question-Compends, and supplies the same excellent means of review and summary of more extensive reading that has characterized the previous numbers of the series. As supplying central points for fixing the attention and furnishing a basis for association, they are most valuable aids to memory.

D. T. S.

The Year Book of Treatment for 1890. A Critical Review for Practitioners of Medicine and Surgery. 12mo, 324 pp. Philadelphia: Lea Brothers & Co. 1890.

The Students' Surgery; A Multum in Parvo. By Frederick James Gant, F. R. C. S., Senior Surgeon to the Royal Free Hospital. 12mo, 817 pp., cloth. Price, $3.75. Philadelphia: Lea Brothers & Co. 1890.

Food in Health and Disease. By J. Burney Yeo, M. D., F. R. C. P., Professor of Clinical Therapeutics in King's College, London, and Physician to King's College Hospital. 12mo, 583. Price, $2.00, cloth. Philadeladelphia: Lea Brothers & Co. 1890.

Manual of Skin Diseases, with Special Ref erence to Diagnosis and Treatment. For Students and General Practitioners. By W. A. Hardaway, M. D., Professor of Skin Diseases in the Missouri Medical College, etc. 12mo, 434 PP., cloth. St. Louis, Mo: Theo. F. Lang. 1890.

Essentials of Gynecology. Arranged in the form of Questions and Answers. Prepared especially for Students of Medicine. By Elwin B. Cragin, M. D., Gynecologist to the Roosevelt Hospital. Fifty-eight illustrations. 12mo, 192 pp. Philadelphia: W. B. Saunders. 1890.

The Pulse. By W. H. Broadbent, M. D., F. R. C. P., Senior Physician to and Lecturer on Clinical Medicine in the Medical School of St. Mary's Hospital, etc. Illustrated with fifty Sphygmographic Tracings. 12mo. Price, $1.75, cloth. 312 pp. Philadelphia: Lea Brothers & Co. 1890.

The Neuroses of the Genito-Urinary System in the Male, with Sterility and Impotence. By Dr. R. Ultzmann, Professor of Genito-Urinary Diseases in the University of Vienna. Translated by Gardner W. Allen, M. D., Surgeon Genito-Urinary Department Boston Dispensary. 12mo, 160 pp., cloth. Price, $1.00 net. Philadelphia: F. A. Davis. 1890.

History and Pathology of Vaccination, in Two Volumes: Vol. I, A Critical Inquiry; Vol. II Selected Papers. By Edgar M. Crookshank, M. B., Professor of Comparative Pathology and Bacteriology and Fellow of King's College, London. 8vo. Vol. I, pp. 466; Vol. II, pp. 610. Cloth, illustrated. Philadelphia: P. Blakiston, Son & Co. 1890.

The Examination of Urine, Chemically and Microscopically, for Clinical Purposes. Ar ranged in the form of Questions and Answers. By Lawrence Wolff, M. D., Physician to the German Hospital of Philadelphia; Demonstator of Chemistry Jefferson Medical College. 12mo, 66 pp., cloth. Price, 75 cents. Philadelphia: W. B. Saunders. 1890.

Essentials of Diseases of the Skin, Including the Syphilodermata. Arranged in the form of Questions and Answers. Prepared especially for Students of Medicine. By Henry W. Stelwagon, M. D., Ph. D., Attending Physician to the Philadelphia Dispensary for Skin Diseases, etc. Seventy-four Illustrations. 12mo, 270 pp. Philadelphia: W. B. Saunders. 1890.

Practical Electricity in Medicine and Surgery. By G. A. Liebig, jr., Ph. D., Assistant in Electricity in Johns Hopkins University, etc., and George H. Rohe, M. D., Professor of Obstetrics and Hygiene College of Physicians and Surgeons, Baltimore, etc. Profusely illustrated. 8vo, 383 pp. Price, $2.00 net, cloth. Philadelphia and London: F. A. Davis. 1890.

A Text-Book of Obstetrics, including the Pathology and Therapeutics of the Puerperal State. Designed for Practitioners and Students of Medicine. By Dr. F. Winckel, Professor of Gynecology and Director of the Royal Hospital for Women, etc., in the University of Munich. Translated from the first German edition, with permission of the author under the supervision of J. Clifton Edgar, A. M., M. D.,

Adjunct Professor of Obstetrics in the Medical Department of the University of New York. One hundred and ninety illustrations. 8vo, 927 pp. Price, cloth, $6.00; sheep, $7.00. Philadelphia: P. Blakiston, Son & Co. 1890.

Correspondence.

LONDON LETTER.

[FROM OUR SPECIAL CORRESPONDENT.]

The origin of the recent influenza epidemic has just been described by a medical man who saw the malady first break out in the Central Asian Khanate of Bokhara. He traces the primary cause as far back as the summer of 1888, which was exceptionally hot and dry, and was followed by a most bitter winter and rainy spring. The dried-up earth was full of cracks and holes from drought and subsequent frost, so that the spring rains of 1889 formed ponds and lakes in these holes throughout the Khanate, inundated the new railway cuttings, and turned the country into a perfect marsh. When the hot weather set in the water gave off poisonous exhalations, rendering malaria general. As the winter had been so severe the Bokharists were obliged to spend money on firing instead of food, so that they were weak from want of nourishment, while the severe frost of Ramadan further reduced their

strength to resist disease. Then the influenza epidemic appeared suddenly and the enfeebled inhabitants died off in large numbers, while the Europeans suffered so severely that at one time all the city were in bed, and there was no one left to nurse the invalids. As soon as the sufferers became convalescent they hurried home by way of Russia for change of air and good nursing. Evidently he considers they took the infection with them, for the epidemic traveled westward along the Central Asian Railway to break out at St. Petersburg in October, and thence spread over all Europe.

Some time ago the London County Council appointed a committee to consider the question whether it would be expedient to establish a hospital for the study and curative treatment of insanity. The committee has consulted the highest authorities on the subject, and the re

sult of its inquiries and deliberations is that it answers the question decidedly in the affirmative.

The recent intense cold has revived the influenza in many districts. It is calculated that the epidemic has cost the country fully two millions of money through loss of wages, disorganization of business, and insurances paid by the various companies and friendly societies.

At Cambridge the "cubical contents" of the heads of various undergraduates have been measured at different stages of their educational career and the results duly tabulated. An interesting account has just been given to the Senate by Mr. Prior, Tutor of Pembroke College, on the authority of Dr. Venn, "as to the cubical development of the heads of university men between the ages of nineteen and twenty-two." The students are divided into three classes, beginning with the men who read for "high honors; " secondly, the low honor men, and thirdly, "poll men," which, being interpreted, means the majority of students, who content themselves with merely taking a degree. The investigations made disclose the fact that the men who read for high honors enjoy an increase of brain mass which is represented by the figures two hundred and forty at nineteen years old, compared with two hundred and forty-seven at twenty-two. This increase goes on steadily through the three years of the undergraduate course; but while the high-honor men's brains go up seven of these mystic degrees, the second class of brains go up four only. Moreover, in the second class the brain is smaller to start with. Coming to the mass of degree men the astonishing fact is found that their cubical brain capacity advances from two hundred and thirty to two hundred and forty, in other words it has growth even larger than that of wranglers and classical "tripos" men. Most of this growth too takes place in the second year of residence, or just when the students are undergoing teaching for the general examination. The conclusion which the Pembroke tutor wished the Cambridge Senate to draw from these facts was that the general examination was as good an educational instrument as could be desired,

a

and, judging exclusively by additions of cubic inches to the structure of the brain, he appears to have proved his point.

Dr. Dickinson has reported an interesting case of diabetic coma treated by the injection of saline fluid into the veins. The operation was performed upon a woman, aged twentyfive, the subject of diabetes upon whom diabetic coma had succeeded. The fluid employed consisted of chloride of sodium, chloride of potassium, sulphate of soda, phosphate of soda, and bicarbonate of soda, dissolved in water. During an hour and a half one hundred and six ounces of this fluid was injected first into one arm and then into the other. At first there was no apparent change in the patient. Ten minutes, however, after the conclusion of the operation consciousness began to return, in a short time the patient being able to converse and take food. Coma again came on, so that the following day she was much in the same state she was before the injection of the solution. The operation was again performed, one of the veins of the leg being used, into which the fluid was allowed to flow from an elevated funnel. During the proceedings the general aspect of the woman improved, the complexion becoming less livid and the pulse gained vol

ume.

The injection was continued until no less than three hundred and fifty ounces had passed in. At the conclusion of the injection the patient remained unconscious for three quarters of an hour and then recovered consciousness, and remained with no symptoms of drowsiness for nine hours, after which she was at times drowsy, but was sensible for thirty hours, at the end of which time there was a lapse into coma which was fatal. After the operation the urine was of low specific gravity, containing 1.8 per cent of sugar. It gave no acetone reaction, though this had before been strongly marked. The skin, which before had been dry, was moist, but there was no sweating. An interesting point was the fact that within the space of thirty-two hours four hundred and fifty-six ounces had been introduced into the veins. The weight of the patient previous to the first operation was found to be eighty-one and a half pounds; after death the body weighed ninety-three pounds, the gain being, no doubt,

of water. Dr. Dickinson suggested that the free drinking of water should be enforced before diabetic coma was established in cases where it was anticipated.

Dr. C. Theodore Williams has handed to the committee of the Hospital for Consumption and Diseases of the Chest, Brompton, a donation of five hundred guineas, in memory of his father, the late Dr. C. I. B. Williams, who had been connected with the hospital from its foundation, and after whom it was proposed to name a ward. The Brompton Hospital is the only institution of its kind in England, and most authorities refer to it for reliable statistics on the subject of pulmonary diseases. The name of the late Dr. Williams is, in fact, as indelibly associated with pulmonary disease as that of Harvey is with the circulation of the blood.

Dr. Robson Roore has made during recent years many visits to Norway to observe cases of leprosy and to study the clinical features of the disease in that country. He has now embodied his observations in a small volume, with the title of "Leprosy and its Prevention, as Illustrated by Norwegian Experience." Dr. Roore says that all the physicians whom he met in Norway were unanimous that segregation is the most important part in the treatment of leprosy.

The Council of the Sanitary Institute have accepted the invitation from the Town Council of Brighton to hold its autumn Congress and Health Exhibition in that town in September

next.

LONDON, March, 1890.

Abstracts and Selections.

THE USE OF VERATRUM VIRIDE IN THE TREATMENT OF DISEASES.-I beg leave to introduce to the notice of the Section a few remarks upon the properties and use of the veratrum viride. We all know of its remarkable properties in reducing the frequency of the pulse. This is a property which renders it particularly valuable in diseases, and for which it has been prescribed in fevers, with extreme rapidity of circulation, and in inflammatory affections of the lungs. It diminishes the pulsations of the heart and arteries twenty

or thirty strokes in a few hours, simply by its action upon the brain and nervous system. Its powers, I am induced to think from some trials with it, will be found of more value in chronic affections, and as little has been stated of its application to these cases, I shall be excused for calling your attention to some of these diseases, in which, after a moderate experience, I am disposed to think it will prove a valuable agent. These are, first, affections of the head, and all the kindred complaints. connected with undue excitement of this organ. These diseases are exhibited in every variety of form, from dullness of the faculties, with heaviness, stupor or oppression, to those more exalted conditions of the same organs, as manifested in extreme nervousness, keen sensibility, and finally perverted reason. These various grades of excitement are connected with undue vascular action, and this again with organic structure. Any article which operates so efficiently upon the vascular system, must have its influences first exerted upon the seat and center of all the vital operations of the body, and it is to sedation, then, that we are to ascribe its beneficial effects in the diseases I am about to bring to your notice.

The simplest disorder of the head in which its good effects are manifested is in vascular fullness of this organ, particularly manifested in the advanced periods of life. The symptoms following upon this state of the brain, and giddiness, dullness of the mental faculties, constant headache, dimness or darkness of vision, the movements of the body being much circumscribed. For the removal of these symptoms I have have found the tincture, largely diluted with water, and taken at regular intervals during the day, very effectual. The form of administration is the following: Tinct. verat. vir., gtt. xxv; aqua, 3 vi. M. The dose is 3ij to 3 iv every two or three hours until relief is is obtained. The doses operate favorably, often without any sensible evacuation, sometimes only to give regularity to the bowels. The next class of cases are those connected with a greater degree of vascular action, and the first that I shall bring to your notice is epilepsy, and unconnected with any mechanical derangement, but a nervous affection, as when it is brought on by grief or mental disappointment.

In a case of this nature, the same formula for its administration, as already mentioned, has been efficacious in diminishing the frequency of the paroxysms and of rendering them milder. From a daily recurrence, they have been suspended for a week; and from a violence in their action, attended with convulsive contraction, they have been reduced

Another class of diseases of the same organ is that characterized by extreme nervousness, or such exaltation of nervous excitement as borders on mania. We recognize in such subjects extreme vivacity, with alternate dejection of spirits, cephalalgia, febricula, impaired digestion, coldness of the extremities, sallow complexion; subjects as described seem to be on the verge of insanity, and, without proper care, pass rapidly into all its wildness and extravagances. Temperance alone holds the reins and keeps the system from rushing headlong on destruction. With this, so valuable a mentor, our medicine strongly coöperates, and, in a case from which my description was drawn, was found highly useful in repressing exuberances and extravagances of feeling and conduct, which gave to those about the patient the impression of madness approaching, while it calmed and relieved the bodily indispositions. The same form of administration was pursued as in the preceding.

In one other form of disease, of a cerebrospinal character, viz., crural neuralgia of the lower extremities, the virtues of this article have been tested. This disease has the misnomer, rheumatism, too frequently applied to it, which it too often resenibles in its worst features; and without some suitable and reasonable remedy the patient is doomed, I might say, to a life of confinement and of suffering. I will not detain you by referring to its causes. In general terms, it is produced by whatever gives rise to inflammation of the spinal column, particularly about the lumbar portion, as lifting heavy weights. After an extensive employment of many articles, I have derived almost immediate relief from the veratrum, the pains in the limbs being greatly mitigated, the uneasiness of the back relieved, the power of locomotion regained in a very short time after commencing the use of it.

Another form of disease of rather different character, but in which, from its reputed operation, it may be considered useful, is in cancerous affections. An article which, from its sedative influence upon the human system, could reduce the pulsations of the heart and arteries twenty, thirty, or forty strokes in the minute, in the course of sixteen or eighteen

hours, must be considered a useful agent in this disease, attended, as it is, with an exalted state of nervous sensibilities. It was a very suitable subject for experiment, and without any authority, but with an eye to its reputed qualities, I considered that it might be advantageously resorted to. Accordingly, in a case of carcinomi uteri, where the sufferings of the patient were of the usual intense character, I have succeeded in affording very great relief, and this without any of the narcotism induced by the preparations of opium. A great change has been brought about in the sufferings and condition of the patient, and from many painful hours by day and sleepless ones by night she has come to enjoy comparative ease, the paroxysms of pain being less frequently renewed, and no night passing without quiet sleep of

from four to six hours. The form of administration is that already detailed: Tinct. verat. virid., gtt. xxv or xxx; aqua, 3 vj; dose, 3 ss, taken every two or three hours. This quantity was given daily, without producing any great uneasiness of stomach; and when, from long use, its powers began to subside, they have been subtained by the addition of 3 to 3jss of laudanum to the mixture, and this quantity taken in the twenty-four hours. By this compound unwonted energy has been given to the mixture, an effect too great from the amount of laudanum added, so much so, that for the past forty-eight hours comparative tranquility has prevailed, and many hours of sleep obtained. In a disease of such a character, any addition which can be made to our resources in counteracting its malignant disposition is a duty we owe to our patients, and a great relief to the physician; and it is from the satisfaction I have felt from this single trial that I have been induced (thus precipitately, as may be thought) to proclaim its efficacy. To alleviate pain is as much the province of the physi cian as to cure disease; and since in many it is all the relief we can aim at, and fate decrees that we must die, it is no less the duty of the physician to soothe and soften the horrors of its approach, and let the passage at least be easy and serene.

These are the few diseases in which I have tested its operation, and they are of a different character from any in which it has been recommended. I may be only on the threshold of inquiry, and it is with a view to elict from others more information, or a confirmation of my statements, that I have been induced, rather hurriedly, to bring them to the notice of the Association. I have consumed, in these experiments, between two and three ounces of the tincture, and have not known any unpleas ant effects produced from the use of it. From