possible to get the family of a patient to carry out properly methods of disinfection ordered by the physician. If the sanitarians ever realized their dream of stamping out the disease, their measures to the purpose must be carried out under the direction of a medical police. Absolute cleanliness, the immediate removal of excreta, and the proper disinfection of the clothing about the patient are essential to success. Right here I would like to enter protest against the coal tar derivatives in the treatment of any disease, and I think the day is not far distant when they will have no interest above that of chemical curiosities. Water in the reduction of temperature will effect any good that is attainable in this direction. When the kindeys are inactive it is generally a sufficient diuretic, though at times some diuretic drug may be effectively employed.

In the proposed laparotomy by Dr. Cecil I can see nothing but a device for effecting the quick transit of the patient over Jordan.

Such symptoms as can not be met with diet, rest, opium, water, and a few like simple measures, I take it will never be held in check.

Dr. F. C. Wilson: The disposal of the excreta is the most important prophylactic consideration relative to typhoid, since the disease would seem to be propagated through the medium of the feces. It is my habit to carefully avoid the throwing of the patient's stools into the vault or water closet. It is best to have them put into a pit dug for the purpose.

In my opinion the essayist neglected to dwell sufficiently upon the complications of the disease. Prominent among these is hemorrhage. It is recognized by a sudden fall in temperature, a thready pulse, and pallor. These symptoms often precede the appearance of blood in the stools. In this condition opium is the sheet anchor, while ice should be applied to the seat of ulceration, and turpentine given by mouth, and ergot or its alkaloid hypodermically. Stimulants in large doses must not be neglected here, and they must be kept up till their effect is visible.

Dr. H. Pusey said, in reference to second attacks of the disease, that he knew a man who had had typhoid fever four times. He believes that alcohol has a marked influence in reducing temperature.

Dr. T. L. McDermott: In reference to proposed laparotomy in perforation, I can not see how it could be effective. Patients with perforation decline with great rapidity, and most, if not all, would die under the surgeon's knife. I have, however, seen some patients with hemorrhage and in collapse who got well. The two most important points in the management of typhoid fever are, keep the patient at rest and avoid purgatives. Sometimes in insomnia I give a hypnotic, but as a rule I give no medicine beyond a little spirit of mindererus and some camphor water. I don't feel any more uneasiness about a case of typhoid than I do about a case of measles. In the course of either one serious complications may arise, but the majority of cases will pull through. In regard to prophylaxis, etiology, infection, etc., we have still much to learn.

Dr. H. A. Cottell said: It would seem that about the only interest attaching to the discussion of a subject so hackneyed as the treatment of typhoid fever is the difference of opinion among the doctors so discussing it. I am inclined to differ with the essayist in the use of the word contagion relative to typhoid fever. The terms contagion and infection are not today employed in the sense attributed to them by the elder Flint. He said a contagious disease was one transmitted by personal contact-for example, syphilis; while an infectious disease was one transmitted through some medium-the air, for instance; and he cited smallpox as an example of a disease that is both contagious and infectious. This was before the office of pathogenic microbes was understood. To-day we hold a disease to be contagious that transmits itself by personal contact, by inoculation, by formities, or directly through the medium of the atmosphere. By an infectious disease we mean one whose specific microbes must pass from the first subject into a nidus, where they undergo proliferation or development before they can reproduce the disease in a second subject. According to this acceptation of the terms, typhoid fever is probably not contagious, but infectious. There is good warrant for the opinion to-day that typhoid fever is always transmitted by the feces of the patient (which contain the typhoid bacillus

by the million) having found entrance into the, food, water, or milk consumed by the victim. If this be true, the disease is distinctly preventable. First, destroy, if possible, by heat, all feces of typhoid fever patients; but since this is not possible, advise all your families to boil all milk and water before drinking them, and to eat no uncooked food. If this suggestion were religiously carried out, typhoid fever would disappear from the face of the earth. As for medicines, I would say that water, opium, turpentine, digitalis, strychnine, and whisky in the hands of the skillful physician will effect all the good that can be effected in the disease. I commend the author's good judgment in omitting mention of the chemical antipyretics. They are not only worthless therapeutically, but have power to do great mischief in any asthenic affection.

Dr. M. Thum said that in the early stage of the disease he always gives a dose of calomel. In cases where cardiac weakness is apparent he uses camphor and whisky. He has little faith in the effectiveness of so-called prophylactic measures.

He

Dr. Turner Anderson said that he desired to be put on record as condemning in toto the exhibition of the chemical antipyretics (coal tar derivations, etc.) in typhoid fever. does not give much opium, holding it in reserve for special indications. The digestive function should be conserved as far as possible. He is therefore very careful not to overfeed the patient. He regards turpentine as one of our best medicines in typhoid fever. He allows an abundance of water. He does not believe that calomel, iodine, or carbolic acid do any good in the fever. He gives as little medicine as possible.

Dr. Irwin, closing the discussion, said: In regard to the use of the chemical antipyretics I deem it useless to speak. That they are worthless in the treatment of typhoid fever, most clinicians will to-day agree. I believe the disease to be contagious, at least in the sense of portability, since nurses seem to carry it from family to family. Alcohol, I think, is valuable only in supporting a weak heart; but it does seem to exert a salutary effect upon the deleted nerve centers. Opium is our sheet

anchor. I give it in small doses. I don't believe in calomel here; if the bowels need moving, give some mild laxative or an enema. Absolute rest should be secured, if possible. F. C. SIMPSON, M. D.,

Secretary.

Reviews and Bibliography.

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, of 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. One hundred and ninety illustrations. 927 pp. Price, cloth, $6.00; sheep, $7.00. Philadelphia: P. Blakiston, Son & Co. 1890.

Possessed of vast experience, of great learning, and of every desired facility as he is, it was not to be expected that a text-book from the hands of Winckel would fall behind any. work previously given to the world. In fullness it is certainly not surpassed, and in features that relate to style and arrangement, to a graphic and vivid presentation of the subject successful comparison with it can not be made in favor of any other work. Even in this regard it may be said of it that it will compare most favorably with any other translation from the German.

Unfavorable criticism of its teachings in the main seems impossible, and it remains only to point out some of the dicta of the author as regards certain points in regard to which the current teachings may be unsettled.

The author believes that fecundation, though mostly taking place in the uterus, may not only take place in the tubes, but also in the ovaries; in this respect differing from the very positive teachings of Lawson Tait.

The source of the liquor amnii he thinks to be mainly the maternal vessels, but that undoubtedly the skin and kidneys of the fetus, the placenta and umbilical cord, contribute to the liquor amnii. The amnion, indeed, seems to possess in some way the power of self-regulation as to the amount of this fluid it shall contain.

The signs of pregnancy are given more fully than we have anywhere else seen, though not presented with exceptional clearness.

The chapter on position of the child in utero is opened with the declaration that the position of the fetus in the uterus, and its causes, is a phenomenon that has caused physicians of all times and races a headache, and closes a careful and able discussion of the matter by giving his conclusion that "the predominance of head presentations is due to the direction of the forces of the uterus, the greater size of the fundus uteri compared with the lower segment, the greater mobility of the child's head, the shape of the uterus and child, the one adapting itself to the other best in head presentations."

This leaves little to be accomplished by the motions of the child, which many hold to be the determining cause almost exclusively. By a settled law of physics the feet and legs of the child when kicked out must move in the line of least resistance; that is, they will always move toward the surface of the fluid in which they move, for movement in this direction is easier than the opposite. The legs then taking the direction of the fundus, which is nearly always the higher part, of necessity turn the head in the opposite direction, where it is held by the shape of the uterus and by the similar continued movements of the fetus. The child in a very simple way by the most natural movements swims head foremost down to the outlet. In all difference this is confidently offered as a good prescription for the headache suffered by physicians of all times and races, as asserted by the author. The chapter or small part of a chapter devoted to rotation is obscure and unsatisfactory to such a degree that the student who had no other source of knowledge would scarcely realize that such a thing occurs. Indeed, about all we can find is embraced in the following brief sentence: "The occiput glides forward above the spina ischii, because the latter opposes an obstacle to advancement in the backward direction; it also passes forward because there is more space there than between the spine and the side of the sacrum; furthermore, on account of the lesser resistance at that point; and lastly, because the inclined plane readily allows it to turn anteriorly."

After the experiments of Dubois with the fetus on the cadaver, showing that the spines have actually nothing to do with rotation, the wonder is that such lines could be penned by so eminent a master as Winckel. With many other examples, it goes to show that his eminence is that of the scientist and man of practical turn, and not that of the philosopher and the physicist.

We pass over many good things till we come to the treatment of the third stage of labor, and here we must halt and applaud. He declares that Credé borrowed from England and Ireland the method which bears his name, and introduced it into Germany. He furthermore shows that the method is as old as history, and to-day widely prevalent among uncivilized peoples. One apt quotation is made from the Chinese, advising women in such cases, the puerperal woman, not to be frightened, “for many die because they listen to midwives and allow them to lay hands upon them." And the author himself contends that "a force which has sufficed to bring forth a child to the light of day, in spite of the resistance offered by the pelvis, the soft parts, and the child itself, will be capable of ejecting the less resisting placenta without the help of our hands." Only in case of excessive hemorrhage, or if the action of the abdominal muscles is insufficient and the average stage of two hours has been exceeded, does he recommend the employment of a modification of Credé's method. ification of Crede's method. And if the signs of the times are rightly read, no matter how widely prevalent the Credé method now is, the day is not far distant when it will be at least. not more employed than is recommended by the author.

The treatment of eclampsia, which the author says he has brought into thorough systematic use in his clinics within the last ten years, is practically that which has been in use in Louisville among some of the best obstetricians for twenty years, viz., the eliminative, and for which the foundation was laid by Meadows in his excellent monogragh. But while we use jalap and Rochelle salts or bitartrate of potash he uses aloes with colecynth as the hydrogogue. The actual paroxysm is treated with chloroform and chloral. He thinks the recommendation

for the premature operative termination of labor in such cases ought to be considered as obsolete, a position in which he will be sustained, as we believe, by the verdict of time.

In the citation of authorities one can not but smile when, after reading some great French work, he has temporarily forgotten that any but French authors have contributed any thing to this department of science, he now reads Winckel only to forget that France has done any thing. American authors, however, are not slighted, and of these Parvin seems to be the special favorite.

Hand-Book of Materia Medica, Pharmacy, and Therapeutics, including the Physiological Action of Drugs, the Special Therapeutics of Disease, Official and Extemporaneous Pharmacy, and Minute Directions for Prescription Writing. By SAMUEL O. L. POTTER, A. M., M. D. Second edition. Revised and enlarged. 766 pp. Price, cloth, $4.00; leather, $5.00. Philadelphia: P. Blakiston, Son & Co. 1890.

In the preparation of this hand-book Dr. Potter has struck upon a happy method of arrangement for his materials that appeals at once to the good judgment of his readers, and renders his book one of the most convenient for reference of the entire list of works in this line. While not by any means as full as several of the larger works, it yet embraces all that is of value in the therapeutical action of drugs, so arranged that reference becomes a matter of the greatest ease. In addition to this, he has formulated definite directions for the framing of prescriptions, and gives also a great deal of information on the subject of pharmacy, thus fully equipping the practitioner for his work, it matters not how much he may have to cultivate self-reliance in his practice.

By far the best part of the book is the portion relating to therapeutics, where each disease is given in alphabetical order with the remedies appropriate for each. Perhaps the the most distinguishing feature of the book is its adaptation for ready reference.

The author is already well known through his admirable contributions to Blakiston's Quiz Compends, and this crowning work has already

met with extended favor.

D. T. S.

Railway Surgery. A Practical Work on the Special Department of Railway Surgery, for Railway Surgeons and Practitioners in the General Practice of Surgery. By C. B. STEMEN, A. M., M. D., LL. D. With illustrations. 307 pp. Price, $3.00. St. Louis: J. H. Chambers & Co. 1890. It is obvious at a glance that, except in the perfecting of arrangements for promptly and speedily taking care of the injured, there are few material points of difference between railway surgery and the surgery of similar accidents in any other department. The author, therefore, quite appropriately announces that his work is also for practitioners in the general practice of surgery. In the various chapters he treats of the transportation of injured railway men, temporary treatment in railroad injuries, shock, anesthetics, lacerated wounds, fractures, amputations, hemorrhage, excision of joints and bones, concussion and compression of the brain, burns and scalds, color blindness, injuries to hands and feet, railway concussion of the spine, transfusion, aneurism, and the method of taking care of the sick on foreign railroads.

The tone of discussion of mooted points is elevated and fair, while the work contains much in the way of a record of illustration and of interesting facts. Of especial interest is the chapter on railway spine, and the conclusions bear the impress rather of an impartial judge than of one closely engaged in railway service.

J. B. Lippincott Company announce in press an important work on "Regional Anatomy in its Relation to Medicine and Surgery." By George McClellan, M. D., Lecturer on Descriptive and Regional Anatomy at the Pennsylva nia School of Anatomy, Professor of Anatomy at the Pennsylvania Academy of Fine Arts, member of the Association of American Anatomists, Academy of Natural Science, Academy Surgery, College of Physicians, etc., of Pennsylvania. With about one hundred full-page fac simile illustrations, reproduced from photographs, taken by the author, of his own dissections, expressly designed and prepared for this work, and colored by him after nature. To be complete in two volumes of about 250 pages each. Large quarto.

The object of the work is to convey a practical knowledge of regional anatomy of the entire body. The text to embrace, besides a clear description of the part in systematic order, the most recent and reliable information regarding anatomy in its medical and surgical relations. The illustrations are intended to verify the text and to bring before the reader the parts under consideration in as realistic a manner as possible. Volume I will be ready for publication about December 1st, and the second volume is expected to appear shortly thereafter. The work will be sold by subscription only; salesmen will begin an active canvass the coming

October.

Correspondence.

LONDON LETTER.

[From our Special Correspondent.]

The cure for consumption which Professor Koch claims to have discovered is to be tried. on several patients in a Berlin hospital. Hitherto the German doctor has only experimentalized on animals.

Attention has just been drawn to the fact that old decomposed blood stains, from which water will no longer dissolve out the coloring matter, should be treated with a solution of potash and soda. If hematin be present it will pass into solution, and the filtered liquid will appear green in a thin layer or red in a thick layer. The solution will also contain iron, which may be detected in the ash when the solution is evaporated and the residue ignited. The evaporation and ignition for this purpose must be conducted in silver and not in porcelain vessels, since the latter give up an appreciable amount of iron. It is found likely that a minute quantity of iron may exist in the potash or soda employed for this test, and this must be looked to. Experiments are about to be conducted as to the characters observed when the alkaline solution is examined by means of the spectroscope.

Lady Roberts has been untiring in her exertions on behalf of providing trained lady nurses for our Indian military hospitals, and has now placed three nurses at Quetta. It seems to have been an absolute impossibility to find any accommodation for them either in the town or the official buildings, and a home has therefore been built through private generosity, which is now ready for occupation. Thanks to this fund, there are now lady nurses in most of the hill stations and leading military hospitals in India, and it is satisfactory to hear that the medical reports give conclusive evidence as to their usefulness, not only in the far greater comfort with which the invalid soldiers are treated, but in appreciably diminished death rates in the establishments in which they are employed. The Indian Press congratulates Lady Roberts very warmly upon the manner