of the different subjects entirely stripped of all unnecessary verbiage. The book is well adapted to the wants of the student and practitioner and for its intrinsic value is remarkably cheap.

oretical, the subject is one worthy of consideration.

The last chapter of the work is taken up by a description of the use of inhalations. The index of the work is complete, making it quite an easy matter for the

GANS. (3)

The November number of "Wood's Library of Standard Medical Authors" is written by a competent author who has had a vast amount of personal experience. It is the only exclusive monograph on the subject of "Therapeutics of the Respiratory Organs" to our knowledge. The work contains 315 closely printed pages, pages that are certainly not intended for the medical student, but for careful study of the intelligent physician. The author is very thorough in some of the chapters in explaining the many theoretical questions that are simply passed over by authors in works on general therapeutics. It is not without a good reason that we recommend this work to the careful study of every physician who treats diseases of the respiratory organs. This knowledge is far from perfect, and the number of patients enormous who die annually from some form of disease of the respiratory tract. The interesting chapter on alcohol presents some valuable experimental research hitherto not generally observed and accepted by physicians generally. The description of "Pneumatics," under the subdivisions of expectorants, general expectorants, and general disinfectant pneumatics, is thorough and complete. Under the heading of neurotics a great deal of valuable information can be found; the author clearly describes the different combinations of opium to produce the various modified effects, but at the same time he calls attention to the fact that in old age and in infancy it must be employed with skill and caution.

The author carefully reviews recent lit erature concerning the application and efficiency of antiseptic and disinfectant pneumatics, and, while it is largely the

3 By Prosser James, M.D., Lecturer on Materia Medica and Therapeutics at the London Hospital Medical College; Physician to the Hospital for Diseases of the Throat and Chest; Late Physician to North London Consumption Hospital; Consulting Physician to the Children's Home Infirmary, Victoria Park etc. For sale by Robert Clarke & Co., Cincinnati,

may desire to look up in a hurry.

In recent publications of medical literature this work, above all others, can be recommended to the profession. TANGEMAN.

DISEASES OF THE URINARY AND MALE SEXUAL ORGANS. (*)

The tenth volume of "Wood's Library of Standard Medical Authors" is from the pen of Dr. Belfield. In the preface the author criticises his own work, by making the statement that it might have been more perfect if he had given as much time to the preparation of it as he should have done, but this statement certainly does not detract anything from the value of the work. There is scarcely any department of medicine which has afforded a more lucrative field for the charlatan and quack. Not a decade since the announcement of a specialist in diseases of the genito-urinary organs, caused reputable physicians to shrug their shoulders, and not without reason since mystery and ignorance shrouded this subject. The specialist of to-day has to great extent taken from the secret nostrum vender his income by enabling the general practitioner to treat this class of diseases on a scientific basis by placing in their hands just such literature as the work of Dr. Belfield.

The book is divided into two parts, the first nineteen chapters are devoted to a description of diseases of the urinary organs. The sixth chapter on digital examination of the bladder; the seventh on "inspection of the urethra," and the eighth on "determination of the urethral calibre by the urethromometer" show plainly the rapid progress that surgeons have made in this specialty. The chapter on disease of the kidney is well worth reading, it shows considerable preparation. The four last chap

4 By Wm. T. Belfield, M.D., author of Relations of Micro-Organisms to Disease (Cartwright Lectures, 1883); Pathologist to the Cook County Hospital; Surgeon to the Genito Urinary Department, Central Dispensary, Chicago; Physician to Oakwood Retreat, Geneva, Wis.; Professor of Microscopy, Chicago College of Dental Surgery. For sale by Robert Clarke & Co., Cincinnati,

Reynold's, the attacks being almost always the first that the man had had. Abscesses occur oftenest in epidemics of the various exanthematous diseases. The speaker has had one case, that of a physician of this city, in which measles was followed by dysentery, and in fact, by extensive ulceration throughout the whole intestinal tract. The hemorrhages were excessive, so that upon two or three occasions the patient almost bled to death.

Dr. GROESBECK said that a matter of interest on this subject had been brought out by the discussion last night in the Academy, namely, that those soldiers who had measles while in the army came principally from the rural districts; and it was inferred from this that these were usually first attacks, since the men coming from city districts where epidemics of measles are common, had in all probability had the disease already.

Dr. HEIGHWAY, referring to his army experience in Mexico, in 1846, said that soldiers from the rural districts suffered most. At one time the army was encamped upon a ridge along the Rio Grande, the soldiers coming from various states, Illinois, Georgia, Indiana, Missouri and others, and with them all the disease was most prevalent and fatal among those who came from the country districts. The only way to account for this was the assumption that they had lived in thinly populated districts, and thus escaped the contagion of epidemics in childhood. The only medical treatment the soldiers received was syrup of ipecacuanha, which was proved to be a most successful remedy.

If every case we are called upon to treat were careful to follow the description given by text-books and teachers, the practice of medicine would be a simple matter. The beautiful differential diagnosis between pneumonitis and pleuritis is so clearly and unequivocally defined, that the medical student would be surprised to learn of perplexities occurring in any one of the three distinct and exceedingly well marked stages. And typhoid fever, according to the books, is distinguished unmistakeably by the preliminary malaise, the epistaxis, the typical febrile movement, delirium, sordes, meteorism, iliac tenderness, etc. Nothing could be plainer. In the student's hopeful imagination this disease is certainly one which can offer no difficulty to the diagnostician; and the student fondly cherishes the belief that such diseases will never puzzle him.

To dispel such delusive notions, actual contact with sickness is required. Then the young physician will find that typical cases of disease hardly need a description; but the trouble begins with irregular and unusual symptoms. It is no more necessary to note the usual ordinary features of typical cases than it is to study and carefully analyze the clinical history of anamolous ones.

Strange and unexpected phenomena occurring in the course of a disease should be thoughtfully considered and weighed; for it is such that perplex the physician. It would be well if all abnormal and unlooked for features could be recorded rationally instead of being passed by lightly because they are unusual and rare.

There are on the other hand, in every disease, certain natural characteristics of such importance that they can never be emphasized too strongly. When striking examples of such cases occur in practice, it is right to refer to them.

Some typhoid fever cases I have met have features that render them impressive and instructive; therefore I will mention them this evening, though as briefly as possible.

Perforation, is unfortunately, not a rare occurrence in the course of typhoid fever. The first case occurring in a physician's practice leaves an impression which is never forgotten; particularly if the patient's death is sudden, as is the case when it is caused by shock. More often, however, an acute peritonitis is the result of the perforation,

and death comes on in the course of a few days. Very rarely indeed does recovery follow, though it may through inflammatory agglutination of the peritoneum and the serous coat of the intestine; or sometimes, when the opening is small, by fibrinous exudation and the formation of a cicatrix.

Perforation occurs most frequently from the third to the fifth week, though beyond these extremes the patient is not free from its dangers. The agminated glands of the lower part of the ileum are most liable to deepest ulceration, and it is here that perforation is most common.

An illustrative case was under my care a year ago. At the end of three weeks the young man was doing very well indeed, and I had begun to feel that danger was over; I had successfully withstood the patient's pleas and those of his friends for a more extensive diet than milk; and I thought that they all appreciated the necessity of his remaining quiet in bed. But as every thing was progressing so favorably, the nurse began to relax the stringency of her rules and become careless in watching the patient. The patient himself felt that my injunctions of absolute quiet were unnecessary and irksome. So, one day, when left alone for a few minutes he attempted to rise from the bed, but fell to the floor exhausted and died in a few hours from collapse, or perhaps from internal hemor rhage, the result in all probability of perforation caused by the muscular movement. It is happily rare that such terrible accidents occur. One case of the kind is enough to leave a permanent impression upon the friends and attendants alike. And if the physician, after such a startling lesson errs, it is in the commendable direction of over-caution.

CASE 2. Benjamin K., aged 16, was affected with an ordinary typhoid fever except that diarrhea was persistent and often severe. And it must be confessed that for this complication a plan of treatment was adopted, which though authorized, I believe would have resulted fatally, had it been continued longer. Simple astringents were given at first, though without benefit. Then tincture of opium was ordered in large doses; the diarrhea was thus speedily checked, but in a few hours the most alarming symptoms came on; the fever rose rapidly, the patient became weaker and worse in every way. A fatal termination

seemed imminent. A consulting physician was sent for, and upon his advice I discontinued the opium; and turpentine with carbolic acid was given in small frequently repeated doses. After two hours the alarming symptoms began to disappear gradually. This treatment was continued and ultimately the patient recovered.

My experience in this case was so impressive that I have never since ventured to give opium to check the diarrhea of typhoid; though its employment is countenanced and even advocated by some high authorities in medicine.

The rational treatment of typhoid fever involves the elimination of the infectious matters in the alimentary tract. These matters are poisonous and exceedingly irritating, and the diarrhea is an effort of nature to remove them. Opium and simple astringents check elimination and should therefore not be used. Such remedies as favor the discharge of the noxious material, should be employed, though they may increase the diarrhea for a time and thus temporarily add to the dangers of hemorrhage or perforation. But the infectious irritant must be removed at all hazards. For this purpose some mercurial preparation may be employed; calomel in large doses is advised by leading writers; corrosive sublimate is advocated by recent authorities, and it possesses the additional advantage of greater. antiseptic properties than those of the mild chloride. Blue mass also has been used. Turpentine is always given with advantage in these irritable and inflammatory conditions of the alimentary tract; and carbolic acid is one of our most effective and reliable agents in the treatment of this disease.

From my experience I have come to regard the last two remedies combined as the sheet-anchor in typhoid, as opium is in peritonitis.

But the employment of turpentine in rare cases is attended with a possible danger which must not be forgotten. Within the past month a case has come under my observation illustrative of the physiological effects of turpentine upon the genito-urinary system.

A delicate school-boy, eight years of age, was effected with a mild case of typhoid fever. I prescribed about two minims of turpentine every two hours; on the third day his mother informed me that the boy had painful micturition, and the expulsion