the extension of the lesions of the cord to the brain, or to the formation in the brain of isolated patches of disease springing from the same cause as the chief disorder in the cord.-Brain. DISINFECTING THE SPUTA OF PHTHISIS. Dr. J. Sormani, Professor of Hygiene at the University of Pavia, gave some interesting details at the Hygienic Congress at the Hague, concerning experiments made this year on one hundred and fifty guinea pigs with the sputa from phthisis. The object in each case was to ascertain what chemical or other methods would neutralize the action of the bacillus which it was previously ascertained, existed in large numbers in the sputa. The results of these experiments were summarized in the following manner: 1. The bacillus of tuberculosis were generally very difficult to destroy; dryness, exposure to oxygen, putrefaction, and most disinfectants failed to produce any effect. 2. A temperature of 100° C. only killed the bacilli after at least five minutes of ebullition. 3. The artificial digestion of the bacilli showed that they were the last of all living organisms to be destroyed by the digestive juices or chloridic acid. A very active digestion is necessary to kill this microbe. A healthy man may destroy the bacilli in his stomach, but an infant or an adult with his digestive faculties impaired would easily allow the germ to pass the stomach intact, and retain its virulence in the intestinal tube. This determined enteric ulcerations, etc. 4. The bacillus of tuberculosis can be preserved intact for a whole year when mixed with water. It is probable, though not proved, that it has retained its virulence during that time. Thus drinking water may become the means of propagating tuberculosis. It is probable that contaminated linen retains its virulence for five or six months. 5. Alcohol does not destroy the germ, and hard drinkers often suffer from tuberculosis. 6. Codliver oil, ozone, oxygenated preparations and other similar remedies have no effect in killing the bacillus, nor are benzoate of sodium, salicylate of sodium, sulphate of zinc and carbolic acid, iodide of silver, bromide of camphor, etc. of much The HISTOLOGICAL ALTERATIONS OF THE MEDULLA OBLONGATA AND VAGI WHICH DETERMINE THE PHENOMENON OF CHEYNESTOKES RESPIRATION.-In this paper (Resoconto dell' Accad. delle Scienze dell Bologna), Tizzoni gives the histological report of a case in which Cheyne-Stokes respiration was occasioned by a chronic ascending neuritis of the vagi and by a disseminated sclerosis of the medulla oblongata, in sequence to grave heart-disease. neuritis, affecting the nerves generally in their peripheral parts, became more limited as it approached their central parts; it was accompanied in some points by infiltrations of blood into the endoneural and perineural lymphatic spaces, and on the right side only reached the medulla oblongata. The lesion of the bulb (sclerosis) on one side ascended the large root of the vagus, and on the other extended along the zonal layer and, reaching the raphe, proceeded from the anterior towards the posterior parts, not affecting the grey substance of the fourth ventricle except for about half of the bulb, and for a very limited extent. In this part, the sclerotic patches were seated principally in the raphe crossing the grey substance and in the ependyma carpeting the longitudinal sulcus of the fourth ventrical (granular sclerosis of the ependyma); and from these points the sclerotic process was diffused to the right along the middle root, at least to the middle or internal nucleus and to the posterior olivary nucleus of the same side, reaching by this way the sclerotic process ascending the large root of the vagus. No alteration was found in the nucleus in the motor-root of the pneumogastric. Therefore, this lesion of the bulb involved a very very unreasonable to attempt to cure an organic disease with drugs, or, indeed to try to cure it at all. Hygienic precautions always will, of course, and always do render the ill effects of organic disease much less potent; but when we talk about cures, we are going too far. Yet in this article Professor Testa reports his observations on the cur the heart. He gives it in pill form every two hours, until one grain is taken during the day, We do not suppose that it can do any harm; therefore our readers might try it if they see fit; but it seems to us that hygiene will give much more satisfactory results.--Méd. and Surg. Reporter. DR. AUSTIN FLINT, JR., adds four more to the American Medical Association. limited portion of the origin of the right vagus, and by its seat finally divided on the right the centre of respiration into two parts, one superior and one inferior. In a case also in which the Cheyne-Stokes phenomenon was determined by uræmia from kidney-disease, the author demonstrates the bilateral lesions of the bulb, identical in site and nature to those descib-ative effect of iodoform in organic disease of ed in the preceding case, although in a much less advanced grade. But although in the two cases described, morbid processes so different had determined identical lesions in the central nervous system, the author does not think that in every case there are always the same lesions to be found; when the phenomenon is transitory, very probably the material alteration is susceptible of resolution, or is not demon-cases of diabetes to the fifty-two reported strable with our present means of research. Hence arises the greater importance of these described cases, since they show, even in those cases in which no material alteration is to be found, to what part of the nervous system is due that functional alteration of the respiration, which constitutes the type of Cheyne Stokes respiration. He denies that in the first case the alterations of the vagus and of the bulb were only in relation with the disease of the heart, since in cases of grave heart-disease not accompanied by Cheyne-Stokes respiration, these lesions have never been found. Finally, he holds that, of the alterations found in the nervous system, those which take the principal part in the production of the Cheyne-Stokes phenomenon are those of the medulla oblongata, those which affect in a determined point the sensory origin of the pneumogastric, either because in the second case lesions of the vagus were absent, or because, in another case very carefully examined, and in which the Cheyne-Stokes phenomenon did not appear, he found slight chronic neuritis of the vagi, without lesion of the bulb. Hence, the alterations of the pneumogastrics in the case of heart-disease with CheyneStokes respiration, represent only one way of diffusion of the morbid process itself from the heart to the centre of respiration. -London Medical Record. IODOFORM IN ORGANIC DISEASE OF THE HEART. When we read this article in the Giornale de Med. e de Ther. di Messine, we truly thought that therapeutics had run wild. It has always seemed to us that it was TANNIN IN CARBUNCLE.- - Dr. R. H. Johnson (Medical Review) has found tannin a specific for carbuncle. The dry powder is sprinkled on the carbuncles as long as it will dissolve. Twenty-four hours after it is washed off with castile soap and the sprinkling of tannin recommenced. The carbuncle soon heals up, he claims, without much pain.-Physician and Surgeon. THE NITER BEDS of Nevada are far better situated for the development of their niter deposits than the niter region of South America, which is a desert entirely devoid of water and all vegetable life, where the development of its niter beds can only be accomplished by surmounting difficulties. Provisions of all kinds must be furnished from distant countries. The water supply for all purposes must be condensed from the ocean water and carried to the niter fields at great expense, while fuel has to be procured from the mountains in the south of Chili at great cost. In Nevada the niter beds are in vicinity of a rich farming country, with wood and water right at hand. These beds are, therefore, on an average able to supply niter, landed in San Francisco, at a much less cost than they are able to produce it in South America. The Nevada Nitre Company will be able to furnish 10,000 tons per annum, at a price that will net $20 per ton profit. The plans for the machinery for developing this tract are completed, and the work of exploration will be initiated very soon. Bibliography. ATLAS OF FEMALE PELVIC ANATOMY. (') This is a quarto of about 100 pages, and contains thirty-six plates, made up of about 150 figures, lithographs and woodcuts. The American edition of this work is accompanied by a brief introduction written by our well-known countryman, Dr. Skeene, which is at once a commendation. Those who have had the good fortune to become familiar with Dr. Hart's former productions: Monograph on the Structural Anatomy of the Female Pelvic Floor, and his joint work with Dr. Barbour, Manual of Gynecology, must have recognized his industry, zeal and ability as an author in these special lines of study. Such persons will come to the examination of the work before us expecting to find it up to a high standard. They will not be disappointed. The author informs us in the preface that "many of the drawings are original, and every care has been taken to make them accurate." The specimens were first photographed, the photographs traced, impressed on stone and the plates then drawn from the photograph and specimen." The method is probably the very best that could be pursued, and so faithfully and skillfully have all details been carried out that the results are perfect, both in artistic beauty and anatomical accuracy. In examining many of the plates it is not difficult to imagine ourselves looking upon the actual tissues, so faithfully are they reproduced. We do not, however, share the opinion of an euthusiastic reviewer that **more correct knowledge of anatomy can be acquired and in much shorter time from the study of such plates than can be acquired by actual dissections. Nothing can take the place of dissections to the student who wishes to acquire a thorough knowledge. Nevertheless, such plates as those in the work before us, more especially accompanied by such full and clearly stated explanatory text as is here presented, must be of incalculable assistance to the student during the prosecution of his dissections. Still greater must be the advantage of such a work to the practical gynecologist and obstetrician, enabling him to retain fresh in memory anatomical knowledge already in his possession, or correcting any inaccuracies that may have confused his conceptions of the form and relations of parts. Reference has already been made to the clearness of the explanatory text. The practical remarks and deductions are also judicious and suggestive. These features add much to the value of the work. In this connection we might call special attention to the discussion of the position of the uterus, the relation of the ureters, the genu-pectoral position, the cervical canal during pregnancy and parturition, etc. The chapter on the structural anatomy of the pelvic floor, perineum, etc., considers the mechanical structure of the female pelvic floor in relation to intra-abdominal pressure, parturition, and the rectal and vesical functions. This chapter is preceeded by plate xxix., which contains 4 figures. Fig. 1 shows a sagittal meseal section of the male pelvis with the loose tissue shaded in black (Ruedinger). Fig. 2. Section of female pelvis with retropubic fat and loose tissue behind bladder and between anterior rectal wall and posterior vaginal wall shaded in black. Fig. 3. Vertical mesial section of uterus, cervix, and opened up pelvic floor in a woman at the end of first stage of labor. This is from the celebrated frozen section of Braune. Fig. 4. Vertical mesial section of prolapsus uteri. These figures are most skillfully employed as illustrative to the discussion in this chapter, which occupies but three pages but which contains more accurate and clearly comprehensible information on the subject presented than can be obtained from any other one source within our knowledge, even at the expense of six times the amount of text. As an example of terseness and clearness of statement we quote from this chapter as follows: "PERINEUM. PERINEAL BODY. "Clinically, the pelvic floor is looked at on its external or skin aspect, and thus obstetricians use the term Perineum in an indefinite sense, applying it usually to the part behind the posterior vaginal wall. Inasmuch as this portion may get torn in a labor, and this tear is often associated with the lesion known as prolapsus uteri, the perineum received an exaggerated importance as an important support. The accurate researches of Henle and Savage have shown the nature and position of the 'perineal body', a pyramid of elastic tissue lying at the inferior aspect ef the sacral segment, or perineum of the older accoucheurs. The perineal body is well seen in fig. 2, plate XI, and is usually 11⁄2 inches high and the the same transversely. From its position be. tween the anal canal and lower portion of posterior vaginal wall, it 1. Deflects anal canal backwards. 2. Gives a fixed point to the perineal and some of the pelvic muscles. 3. Prevents pouching the rectum into the vagina. 4. Strengthens during parturition the inferior margin of the sacral segment where unprotected by bone, and this is like the brass edge on a door step. Neither the perineum, nor the perineal body, nor the posterior vaginal wall alone support the uterus and abdominal viscera. They do so only as parts of the entire fixed portion of the pelvic floor. Thus, the uterus, abdominal viscera and entire displacable portion of the pelvic floor rest on the entire fixed portion, i.e., do not rest on the perineum or perineal body alone." Two beautiful colored plates (XIII and XIV), showing perfectly the blood-vessels of the pelvis injected, seen from the front and from the side, are from the superb Atlas of Bourgery and Jacob. Plate XV, with three figures (from Sappey, Leopold and Hartn), showing the pelvic lymphatic system, with the accompanying text and practical remarks, is exceedingly instructive. Our own country is represented in Plate VIII, which shows Skene's tubules in transverse section of the urethra; also two figures in Plate XI are from Chadwick, one showing the distended rectum, the | other the circular muscular fibres of the rectum. Many of the current inaccuracies of the text-books, such as the form of the socalled perineal body, the patency of the vagina, the form and relations of the bladder, the position of the uterus, etc., are corrected. The difference of opinion held by high authorities as to the normal position of the uterus, is well illustrated in plates XXVII and XXVIII. Fig. 3, plate xxvii (Henle's Section), and fig. 2, plate XX (Luschka's Section), also plate XXII, fig. 1 (Peregoff's Frozen Section), the normal uterus is represented as retroverted. Figs. 1 and 2, plate XXVII (Shultze's Section) show it so much anteverted as to lie almost horizontally. Fig. 1, plate XXVIII (Foster's Diagram) shows the uterus occupying the axis of the pelvic brim. The so-called normal position of the uterus, fig. 4, plate XXVII, (Kohlrausch) with the distended bladder, copied and endorsed by many text books, our author declares very truthfully to be only ideal, and unsupported by any fact. He also truthfully says that the uterus lies normally on the empty bladder, and has the range of position indicated in Van de Warker's diagram. * * * ،، Normally the uterus has a moderate degree of anteflexion. This position holds good for the dorsal posture. In changing to the upright, the uterus sinks down and becomes more anteverted and anteflexed, and somewhat retroposed." (Küstner.). Van de Warker's diagram is given on page 56. The work is divided into six sections : I. Descriptive, Plate I-XVII, in which the pelvis is considered systematically. II. Dissectional, Plate XVIII-XX, in which dissections of the pelvis are taken up chiefly to describe the muscles and facia and relations of organs to them. III. Sectional and Topographical, Plate XXI—XXVIII. IV. Structural and genu-pectoral anatomy, Plate XXIX-XXX. V. Cervical canal in pregnancy and parturition, Plate XXX-XXXV. VI. Microscopical anatomy, Plate I. "Some points on the physics of the bladder and rectum,” 2. "Note on the etiology of flexions." Plate XXXVII, microscopic section showing, fig. 1, Ischio-Rectal Fossa. Fig. 2, Body of Clitoris. Fig. 3, Epithelium of Vagina. Fig. 4. Fallopian Tubes. The work has a well arranged index; also there is appended a thorough bibliography. Throughout the work, both in text and illustration, full credit is given to authors quoted. The letter-press and paper, are in keeping with the high scientific character of the work, and will maintain the enviable reputation already attained by the American publishers. The space allotted us compels this review to be brief and very imperfect. We most unqualifiedly commend the work. Without a word of adverse criticism of other invaluable productions in the same field, we nevertheless unhesitatingly say, we know of no other work that can be satisfactorily substituted. It fills a place of its own. T. A. R. alterations, several chapters entirely rewritten, and some obsolete things left out altogether. Evidently this has been a very laborious work, and after carefully perusing the book all that we have to say is, that the task is well done. One of the most pleasing things about this volume is the frank and honest way in which the writer acknowledges his indebtedness to his American and European confreres. In this day and generation, he who sits down and attempts to write a medical work that will be read and appreciated by his fellows, must avail himself of the accumulated knowledge of German, French and English laborers. This thing of writing a work from the narrow standpoint of individual experience should never be thought of. The first part of Dr. Burnett's work is devoted to the anatomy and physiology of the external ear—the auricle, the external canal, the drum membrane,— the middle ear the tympanic cavity, the Eustachian tube and mastoid portion, and the internal ear, comprising the labyrinth and audi THE EAR, ITS ANATOMY, PHYSIOLOGY, tory nerve. The second part treats of the examination The book before us is a fine, handsome, of patients, the necessary instruments and well printed, well bound volume of 585 patheir employment, the consideration of ges. It contains one hundred and seven il- sound, hearing, and tests of the latter, orlustrations, and is the second edition revis-ganic defects of the auricle and its cutaneed and rewritten. Seven years ago the au- ous affections, including morbid growths and injuries, diseases of the external audithor brought out his first edition; such was the inherent value of the work that it took tory canal, foreign bodies in the external ear, and the results of inflammation and inat once, and has maintained ever since a high place in medical literature. Every line jury; affections of the membrana tympani, showed care and research, and the work including acute and chronic inflammation, contained about all that was worth know-injuries and morbid growths. The remarks ing in otology. Dr. Burnett, although not on sound and hearing, intensity, pitch and an original investigator, is a close student, quality, partial or overtones, musical annoa fine writer and skillful specialist. He has tation, the so-called deaf points of the ear, never gone off into the dreamland of spec- valuable, new and interesting. and sound and color, are all particularly ulation and abstract theory, but has followed closely and carefully along the broad, well beaten paths of medicine and surgery, and practiced and preached to his hearers and readers to hold on to that which we know to be good and safe. The last half dozen years have seen so many changes and advances in the science of otology, that now the author brings out this second edition, in which we find many 2. A Practical Treatise for the use of Students and Practitioners. By Chas. H. Burnett, A.M., M.D. Phila., Henry C. Lea & Co.; Cin'ti, Robt. Clarke & Co. middle ear, and those on deaf-mutism and The chapters devoted to diseases of the partially deaf children must be closely studcriticism we have to make on this work is ied to be appreciated. The only adverse that the author brings to our notice such a the ear, that we wonder if he himself ever vast array of instruments for working around has time to use them all. Into the ear of the publisher we would quietly whisper a word or two in regard to some of the very poor illustrations which sadly mar the otherwise fair text. On the whole, the treatise is a fine ac 1 |