reaches to 10 per cent. The capacity of his lungs is, say, 5,000 c.cm., so that in a few deep breaths he may have taken as much as 500 c.cm. into his lungs. Now 500 c.cm. of chloroform vapor= 1.67 cm. of fluid chloroform. Considering that he has already some chloroform in his system, that during his deep breathing it is pouring in through his lungs, can his death be called surprising? Is that a justifiable death?"

On Dr. Lawrie's plan, especially as supplemented by his new rule, "never to give chloroform while there is struggling and irregular breathing," such a death could never occur, for however much chloroform may be poured on the inhaler, care is taken that that chloroform shall not be inhaled.

Terapia dell' Afasia e

degli altri Disturbi del Linguaggio.

This work is a translation of Dr. Charlton Bastian's book, "Aphasia and other Speech Defects." Dr. Bastian's views on this somewhat intricate subject are well known and, if not universally accepted, are in this work supported by plenty of confirmatory evidence. Shortly, he considers that the so-called motor areas in the brain are really sensory centers of "kinæsthetic type," and in connection with speech processes he believes that there are two centers of this type-a glosso-kinæsthetic center related to articulatory processes and a cheiro-kinæsthetic center in connection with writing processes. Besides these there are an auditory word-center and a visual word-center-sensory centers-and lesions accounting for speech defects are to be looked for in those centers or in the fibers connecting them with each other or with the motor centers in the bulb, or in these motor centers themselves.

Comparative Physiology of the
Brain and Comparative Psychology.

The general thesis which Professor Loeb of Chicago sets out to prove in this book is that, owing to experimental physiology having been for the most part confined to the study of vertebrates, too much importance in the explanation of reflexes and the like has been attached to the nervous system, and especially to its ganglionic portions, and too little to the reactions of protoplasm. In fact, he goes the length of maintaining that, at all events in the case of the simpler reflexes, the nervous system plays no part beyond affording an easy and direct road along which the stimulus can travel. He points out that exactly the same reflexes occur in an Ascidian deprived of its ganglionic center as in one that is intact, the only difference being that they

are a little slower, and may require slightly stronger stimulation. The bell of a medusa, from which the margin containing its ring of ganglionic centers has been cut off, no longer contracts rhythmically, but the detached margin does, as was established by Romanes. Professor Loeb states that this is true only if it be in sea water. If it be placed in a pure solution of salt of the same density, the bell beats rhythmically, as if uninjured; if a small quantity of calcium or potassium chloride be added, it stops. He extends this to the skeletal muscles of higher animals, and states that, by a diminution of calcium salts and an increase of sodium salts, they may be made to contract rhythmically like the heart. Hence he infers that many of the problems of physiology will find their solution in pure physics and chemistry. Instincts are largely relegated to the position of reflexes, more or less complicated. That a moth should fly into the candle is explained by the theory that it has light so long as they act on one side alone; reflexes which act by turning its body to the when the body is directed straight to the light, it is acted upon symmetrically, and it pursues its path into the candle too quickly to be arrested by the heat, which would stop a slower-moving creature. Thus, according to his explanation, the moth cannot help itself. Given a flying moth and a light near enough to affect it strongly, it must fly into it, but the action is automatic, not voluntary.

Many actions which are ordinarily ascribed to conscious intention are by him relegated to a lower plane. He holds that it cannot be correct to say that a child has to learn to walk when a chicken does so the moment it leaves the egg. What is true is that the latter is structurally much more complete, and in the child the nerves and muscles have not attained to the required degree of development. A curious instance of how misleading single experiments may sometimes be is that of a worm bisected transversely; the front half crawls on as if nothing had happened, while the posterior half wriggles in a purposeless way. This might be attributed to the front half containing the "brain," its supraœsophageal ganglion. But cut the back half in two again and its front portion will crawl on and the back piece wriggle, and this may be repeated yet again; or touch it without injuring it with the sharp point of a pencil, and the portion in front of the irritation will creep on and that behind will wriggle, showing that the effect of a stimulus traveling forward or backward along its ventral chain of ganglia is quite different. His book contains much that is original; and even if he appears sometimes to postulate too much in support of his views, and to press them somewhat far, nevertheless it is well worth perusal by every

physiologist. His contention that it is by the study of comparative physiology that we may hope to advance mammalian physiology appears to be fully justified by the experiments he has conducted and by the facts which he gives.

Die Anorganischen Salze

im Menschlichen Organismus.

Specialization is certainly advancing, for we have before us a book by Dr. R. Brasch entirely devoted to the comparatively small question of the inorganic salts of the body. There have been some writers, especially Professor Loeb, who have deplored the scant attention bestowed on the inorganic side of chemistry by physiologists; he regards the action of various ions as the principal cause of such complex phenomena as cardiac and other forms of muscular and protoplasmic rhythm. He has even stated that he has been able to rear larvæ from unfertilized ova by

merely altering their inorganic surroundings. Without committing ourselves to such views at present, we feel bound to admit that Professor Loeb's general accusation is true. According to the present chemical ideas concerning solutions of electrolytes, there is much that is useful in their practical application to such problems as osmosis, which are overwhelmingly important in physiological questions. Dr. R. Brasch's book is useful in drawing attention to such facts. The author is a physician at Kissingen baths, and it is therefore easy to trace how he has been led to write on this particular subject.

Medico-Surgical Aspects

of the Spanish-American War.

This book, by Dr. Nicholas Senn, is apparently a collection of papers and letters contributed to various journals, and this being so, it is not written upon any definitely coherent plan. With regard to wounds inflicted by the smallcaliber jacketed bullet it was noticed that where the wounds were infected it was more often at the wound of exit than at that of entry, a fact which Dr. Senn explains by the larger size of the wound and the greater laceration of the tissues. Dr. Senn lays stress upon what has also been noticed over and over again in South Africa-that more attention must be paid to the value of the first dressing, and he recommends that in every firstdressing package of antiseptic powder should be supplied. He prefers a combination of boric and salicylic acids in the proportion of four to one. The use of the X-rays was found to be very valuable in the location of projectiles. Penetrating gunshot wounds of the abdomen healed in many cases without surgical interference, and Dr. Senn quotes one remarkable instance. A soldier received an injury while lying in the prone posi

tion, the bullet entering the left infra-spinous fossa and passing downwards and inwards until it lodged under the skin in the median line, two inches above the umbilicus. The patient had a good deal of hemoptysis for two days. An abscess formed in the abdominal wall, which was opened eighteen days after the injury and the bullet was removed. After this, rapid improvement occurred.

Medical Diseases of Childhood.

Dr. Oppenheim gives, in a somewhat magniloquent style, an account of these complaints. He has illustrated the text with admirable photomicrographs, but, owing to the communistic, not to say parasitic, principles on which the book has been compiled, there is practically nothing in it which cannot be found in any ordinary textbook. This unfortunate fact is explained in the preface. "In the large brotherhood of science," we are told," there is no distinct ownership, and one man takes up the work of another, completing it or merely utilizing it without regard to the responsibility of its beginning or its end." We are all borrowers from one another, and we all live in a condition of joint ownership." We have, in fact, discovered only three marks of originality in the book. One is the ingenuity with which difficulties which embarrass other people are evaded. The diagnosis, for instance, between non-tuberculous and tuberculous chronic broncho-pneumonia is frequently very hard, but the author tells us simply that "the question is decided against the latter by inability to find the characterictic signs of tuberculosis or its specific bacillus." So where is the difficulty?

66

Another is the language in which the writer clothes the ideas he borrows from the other joint owners. We hear, to give but one example, of "the keen nocturnal note," for all the world as if the meningitic child were a wild fowl. But interest in the many poetic expressions is lost in the excitement of the author's discovery of what a child really is. He is "a mutable being, an organic flux, changing" (horribile dictu) “from week to week, in the endeavor to find a permanent economy that is sufficient for the work of self-preservation and propagation of its kind.” This series of changes develops with wondrous rapidity, and finally "terminates in that dim region where absolute maturity fades away with physical and mental decadence." Something like the end of "She" from the description. This "dim region" is not inhabited by adults, as some have supposed. The child, organic flux that he is, need never dream of becoming an adult, for the latter, the author tells us, "is the same yesterday, to-day, and to-morrow." Dr.

Oppenheim's knowledge of childhood by no means ends here. He can, he assures us confidently, "not only make a clear distinction between the child and the adult, but can also differentiate between the child and the child," and this by the simple device of finding the relative weights of its liver and other organs. Into these subtleties considerations of space forbid us to follow him. We can only say that as a text-book this volume is commonplace, but that it is a veritable mine of unconscious humor.

Decay in the Teeth:

Its Cause and Prevention.

The author is J. Sim Wallace, M. D. His general contention is that there is no evidence of any deterioration in the quality of teeth, and that the prevalence of caries is to be attributed to the nature of the food stuffs employed. The views presented are worthy of careful consideration, but we doubt if they will carry full conviction to the minds of readers. It is true that no physical

or chemical difference has been demonstrated between teeth much affected by caries and those from sound mouths, but our knowledge in this direction is, after all, very imperfect. All that has been shown by those who have investigated the chemical aspect of the matter is that the aggregate proportion of lime salts does not, as was formerly supposed, differ materially in so-called good and bad teeth. But for anything that we know to the contrary the salts may not be the same, and next to nothing is known of the organic matter.

The germ theory of Weismann is cited as an argument that there cannot be any hereditary degeneration of teeth, but this is an inversion of the proper method of inquiry. Pathological facts might well be adduced as arguments for or against the Weismann theory, but deductions based upon a theory not by any means universally accepted cannot safely be used towards establishing pathological facts. As Professor Pearson has repeatedly pointed out, we must accumulate far more facts about heredity before any great generalization can be made.

Much stress is laid upon the necessity for using in a greater degree fibrous and coarse foods, which are less likely to lodge, and if they do lodge will provoke sufficient discomfort to ensure their speedy removal. Attention is also called to a result of the ingestion of much sugar, which altogether itself too soluble to remain long about the teeth, in part undergoes a viscous fermentation resulting in the formation of gum and mannite, which coat the teeth with an adherent film. This is exaggerated when the saliva is scanty, as in some fevers, but does not happen at all when sugar cane is chewed, as the fibrous portion efficiently cleanses the teeth.

There is a further suggestion which is interesting and novel—namely, that the albuminous and neutral coating upon the teeth which is derived from the buccal mucus is absolutely beneficial, as although it is infected with organisms they are not acid-producing organisms. Hence the author goes the length of doubting whether the great use of the toothbrush, which removes this coating, is an unmixed advantage; but before he can hope to convert his readers to this view far more data and experiments must be submitted than are to be found in the brief allusions. contained in the text of his book. The idea is

ingenious, but in the absence of investigations, which might easily be carried out both in animals and in the human subject, it partakes of the nature of a guess.

The Diagnosis and Treatment of the Diseases of the Eye.

Professor Edw. Jackson, the author of this. work, is catholic in his pathology and treatment of ophthalmic disease. He gives mercury in iritis; admits two forms of sympathetic disease— sympathetic inflammation and sympathetic irritation; and acknowledges that up to the present time the etiology of the sympathizing eye, or the channel through which the exciting eye acts. upon the uninjured one, is unknown. He practices iridectomy for cases of increased tension in preference to sclerotomy or Hancock's operation. He uses a knife of his own device for the section of the cornea in the extraction of cataract. It is a narrow Beers knife, with the basal angle much rounded, and no doubt acts well. In this operation it is not so much the form of the knife as the skill with which the operator manipulates it that is of importance, and those who have lived long have seen excellent results with many different forms of instrument. Professor Jackson's incision is made well within the periphery of the cornea and he omits the iridectomy.

On examinations with the ophthalmoscope for the measurement of refraction, the author justly observes that this method cannot be relied upon for the accurate prescription of glasses. On the subject of skiascopy, he concludes his remarks. by recommending to the student the stenopæic slit or the parallel lines with spherical lenses if he cannot use skiascopy or has no ophthalmometer, the usual condition, we imagine, of the student.

Professor Jackson commends the use of glasses at as early an age as three in cases where a tendency to squint is observed. In speaking of myopia he attributes that affection to two circumstances, first, to softening of the scleral coat by congestion; and secondly, to pressure of the muscles around the eyes in fixing near objects.

Surely other potent causes are insufficient light and close work on near objects. He speaks with approval of the removal of the lens in cases of high myopia. We doubt whether it will come into. very general use. The colored illustrations are poor and rough, contrasting badly with the beautiful plates issued by the Germans, that ingenious nation in chromolithography.

Globules.

-The Minnesota State Homeopathic Institute was billed to hold its 35th annual session in the State Capitol Building at St. Paul May 21, 22, 23. The odd slip of a programme (which reached us in due time to have visited there, but not in time to print the notice in our journal) is filled with good titles backed by good namės. And from its former successes we have no reason to doubt that this session was the equal of any of its many predecessors.

-We desire to call attention to the private hospital at Buffalo of our good friend and brother Dr. Dewitt G. Wilcox, the enterprising secretary of the Homeopathic Medical Society of New York. Arrangements have been perfected for the reception of patients during the existence of the Pan-American Exposition, and these arrangements are of the most modern and approved type of excellence. Dr. Wilcox needs no recommendation from us; he is too well known all over the United States as an expert and skillful physician and operator to require any editor's certificate.

-The American Monthly Review of Reviews gives a large share of its most recent issue to an exploitation of the Pan-American Exposition. This is truly a splendid affair, and from present appearances will prove a great financial success. In other departments the Review holds its own field without equal. It is truly refreshing to get each monthly number and review with the editor the events of the month past, and realize how little of what has been filling the morn

ing and evening papers has been of any practical

value. Under the wise condensation of Editor

Shaw and his associates the matters of fact show out plainly, while the matters of fiction and guess are relegated to the background.

-The Century Magazine continues in its excellent way of contributing excellent papers for its readers. "D'ri and I" is taking its place with the other excellent fiction latterly furnished. by this magazine. In the May number "The Japanese Illusion" was a charming bit of story writing and doubtlessly appreciated by all. Reminds us to say that we have an odd habit of ex

amining the advertising pages of our literary journals first, in order to see what is the proper thing to eat, or drink, or wear, or see, or read. For the Century has its ad. pages filled with the most seasonable of articles. It would not be difficult for a modern Rip Van Winkle on waking from a profound sleep to tell, from examining the ad. pages of the Century, in what time of the year, nay, almost the exact month of his waking. The ads. are marvelously well done, both with graver and pen.

-The new Gould journal-American Medicine -comes regularly to our table, and we feel that we have now no longer any complaint because the lordly Medical Journal would not exchange with a homeopathic publication: for Gould's journal is the peer of any of the other journals of its own-and we had almost said of any school -but it is too near election time in the Inst tute to adventure so pronounced an opinion. Dr. Gould is a master in the profession of editorial writing and arranging. With his corps of collaborators the entirely medical field is thoroughly scanned and its important happenings faithfully and succinctly chronicled from week to week.

-The controlling powers of the Royal Arcanum, a fraternal society with an insurance ieature, the best one, probably, of the many organized in America, has recently met and made a ruling which properly places the Mother Eddy fanatics. This controlling body of the order has instructed medical examiners to decline for membership for the life insurance feature all who believe in the vagaries of Christian Science. In other words, those who refuse to recognize disease as an entity are apt to ignore its prevention. Should every life insurance organization of the country take a similar course they would soon help in the solution of the problem.

-During the past few years persistent efforts have been made by unscrupulous and mercenary pharmacists to dispense spurious Phenacetin in physicians' prescriptions. Owing to the great popularity enjoyed by this remedy, even the validity of the patent has been attacked, and for this reason it is particularly gratifying to learn authority sustains the manufacturer's (Farbenthat the opinion rendered by the highest judicial fabriken of Elberfeld Co.) rights after this subject had been submitted to the most searching inquiry. This will naturally apply not only to Phenacetin, but to other popular remedies, Aristol, Sulfonal, Trional, etc.

We emphasize the necessity of physicians assuring themselves that products prescribed are dispensed from the original cartons, for in this way only can they be fully protected against worthless and often injurious imitations.

OUR PORTRAITS.

JOHN ARSCHAGOUNI, M. D., New York.

THE PHYSICIAN'S BURDEN.

The tendency to underrate a physician is one of the inexcusable and disagreeable realities which wait upon the practitioner no matter where he is located. Perhaps the other professions are equally maligned, and we do not know it; or, knowing it, give it but little heed. With the other learned professions there is, we believe, less of the tendency of the members themselves

to blacken each other which seems to inhere in medical lines. It is a common arraignment of a physician that he can't take care of a cat or a dog. If he is a gynecologist; or if women, having found successful treatment at his hands, speak well of him, soon he is marked down as a trafficker in criminal practices, and no woman. is safe in his office. And this does not exclude even the best and the most skillful. If he is a specialist in eyes, then every patient coming to him needs spectacles. A urinary specialist finds everyone afflicted with fearfully fatal disorders. A surgeon botches every broken bone he touches. The general practitioner cannot tell tonsilitis from diphtheria. A renowned obstetrician is charged with waiting for a child to appear where it was only a colloid tumor. If these defamatory opinions were the speeches only of the non-bill-paying laity, then we could bear the disgraceful feature with more equanimity. But unfortunately it is the brother in the guild who has much to answer for in this respect of using his own unkindly. It is he, in many instances, who suggests to a patient the bringing of malpractice suits. If a patient operated upon in a hospital, by reason of the carelessness of some attendant, is burned with hot bottles, some officious brother recommends the bringing of an action against the operator, and so make his life miserable for years to come. For even if the operator wins his case in the end, in the far-off end, meantime he is out of pocket for legal proceedings, time, and in many cases the confidence of some of his former patients. Why cannot this tendency in some members of the profession be wholly eradicated? There is no need-even were it possible-that we all think alike or act alike, even under apparently similar circumstances; but what need to misjudge the