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Sensory neuroses are first discussed, then motor neuroses, and thirdly anatomical diseases of the peripheral nerves, which alone properly deserve the name indicated by the title.

The author, we think, properly considers pain to be, not a specific quality, but merely the effect of any undue intensity of centripetal excitation. All discussion respecting the essence of pain is idle so long as we remain in the dark respecting the true nature of the molecular processes accompanying normal or abnormal excitation of nerves and nerve centres. Though neuralgia is something essentially different from the sensory impressions caused by the immediate action of stimuli in nerves, we are yet in the dark respecting its true pathology. The author does not accept as satisfactory any of the theories as yet propounded to account for it. It is beyond the reach of mere anatomical or coarse pathology. The symptoms of neuralgia in general, and of the special forms of neuralgia, and of the various trophic and vaso-motor disorders accompanying it are well and fully discussed, and in the treatment special attention is devoted to electricity and its application.

In speaking of the treatment of sciatica, our author incidentally mentions the good results which have occasionally been seen to result from the application of the actual cautery to the external ear, and remarks that "our ignorance of its mode of action is no reason why it should be held up to ridicule." We quite concur in the sentiment, believing that well-founded empiricism often affords the most valuable clues to rational pathology and treatment.

Passing from neuralgia to anesthesia, we find the various forms and causes fully discussed. The causes are divided into affections of the peripheral sensory organs, the nerve trunks, conducting paths of the cord of the brain, and lastly of true centric organs. Affections of the cortex, and especially those exemplified in certain forms of mental disease, the author looks on as proving the existence of sensory regions in the cortex cerebri.

In treating of the neuroses of special sense, Erb gives considerable attention to the neuroses of taste, and shows, we think, satisfactorily that the chorda tympani, considered as a branch of the facial, has no relation to taste, but that it receives branches from the lingual nerve, which again leave it and return to this nerve once more. The exact route of their return is uncertain, but that they do so, and do not continue their course to the roots of the facial is clearly established by cases which fully support the experiments of Schiff.

In discussing neuroses of motor nerves, considerable prominence is given to the methods of exploration of the motor apparatus, and more especially to electrical exploration.

The various causes of spasm or convulsion are fairly well

considered; but to say that Nothnagel has demonstrated the existence of a special "convulsive centre" is more than we are willing to admit.

The existence of "pressure points" in certain convulsive affections, ie. points, pressure on which either inhibits or excites spasm, is referred to, and is well worthy of further investigation.

In treating of writer's cramp and allied affections, Erb adopts Benedikt's classification into the spastic, tremulous, and paralytic forms. The pathology is still left in obscurity, and the treatment is equally doubtful. Though electricity may occasionally do good, the prognosis is distinctly unfavourable as yet. As to the centric or peripheral nature of the affection termed tetany nothing definite is known. The various opinions which have been advanced are, however, all carefully reviewed.

On the important question of "contractures," especially those occurring in cerebral paralysis, the author finds himself unable to decide as to which of the views as to their causation he is to give his adhesion. He seems inclined to adopt the hypothesis advanced by Hitzig, that they are due to abnormal excitability of the centres of the associated movements which accompany even the simplest motion of the body. As regards their treatment Erb recommends galvanisation of the head as the most effectual.

The various causes of paralysis, peripheral, spinal, and cerebral, are fully and carefully discussed, and the methods of diagnosis of the seat, particularly by means of electrical exploration, are clearly set forth. On these points Erb has done good service by his own investigations, especially on the galvanic and faradic reactions of paralysed nerves and muscles.

Our space being limited, we cannot enter into further analysis or criticism of this work, but recommend it to our readers as one of the most valuable and exhaustive which has yet appeared, `and fully abreast with all the most recent investigations.

A Text-Book of Electricity in Medicine and Surgery. By GEORGE VIVIAN POORE, M.D., M.R.C.P. London: Smith,

Elder, & Co., 1875.

DR. POORE has done good service in placing in the hands of students and practitioners an extremely concise and useful manual of instruction in a branch of therapeutics far too much neglected in this country. Indeed the most lamentable ignorance prevails generally, and that which, apart from its therapeutic nature, is one of the most important aids to diagnosis in diseases of the nervous system, is left largely in the hands of ignorant and pretentious quacks. No man who has any pretence to acquaintance with diseases of the nervous system can afford to be ignorant of that which in reference to nervous diseases is no

less important than the stethoscope in diseases of the chest. Unfortunately in the great majority of works devoted to the subject there is a tendency to hypertrophy by the introduction of much irrelevant matter, and especially the accumulation of "cases" treated successfully, which tend to repel and confound the reader who wishes for clear and definite principles and rules.

Dr. Poore describes very clearly and succinctly the laws of electricity, the construction of batteries, the physiological effects of galvanic and induced currents on nerves and muscles, and shows how they are to be applied to the body in order to produce certain effects. The diagnostic uses of electricity are briefly but very well laid down. In treating of the therapeutical applications of electricity Dr. Poore discusses it first as a stimulant, giving illustrative cases, and next as an anodyne or sedative. The distinction is a purely hypothetical one, and we do not see any need for encumbering the subject with questionable generalisations borrowed from empirical therapeutics. Dr. Poore must have had very simple readers in his mind's eye when he wrote "there is no relation, etymological or otherwise, between anode and anodyne." Very useful chapters are devoted to the electric cautery and the electrolytic treatment of tumours and aneurisms. We wish all success to the work, for it has many excellences.

Clinical Lectures on Diseases of the Heart and Aorta. By GEO. W. BALFOUR, M.D.,' F.R.C.P., Physician to, and Lecturer on Clinical Medicine in the Royal Infirmary, Edinburgh. J. & A. Churchill, 1876, pp 424.

DR. BALFOUR has been long and favourably known as a steady worker at the diseases of the circulatory organs. Many, if not all, of the chapters of his book have already appeared in the columns of the Edinburgh Medical Journal, and therefore most readers are more or less familiar with his views. Dr. Balfour is strongly inclined to think for himself, and is decidedly competent to do so; and if one cannot always thoroughly agree with him, nevertheless one cannot help feeling that his arguments are well put and his reasoning cogent. His book is not exactly the one we would recommend to beginners of the study of heart disease, as being scarcely sufficiently systematic; but it is a work which is eminently suited for the careful perusal and study of those who are already somewhat familiar with the subject-matter. After a preliminary chapter on diagnosis he plunges into the valvular lesions of the heart, which he has obviously carefully studied. The lesions of the aortic valves are first given, after which the mitral lesions are considered. Mitral stenosis receives elaborate notice, while the lectures on mitral regurgitation will furnish

much that is new to many readers. Lecture VI. is devoted to "curable mitral regurgitation," where a systolic murmur “has its position of maximum intensity, not in the pulmonary area, but · one inch and a half or more to the left of the left edge of the sternum in the second interspace," and "not over the pulmonary artery at all, but exactly over the spot where the appendix of the left auricle comes up from behind, just to the left of that artery." As to the proofs of this statement, the reader must consult the book itself. Tricuspid regurgitation, curable and incurable, engages the next chapter, after which follows the consideration of the murmurs audible in the pulmonary area. Lecture IX. is devoted to the variation and vanishing of cardiac murmurs. In Lecture X., on intermittency, irregularity, and palpitation, cardiac and aortic, we meet with the following sentence (p. 237). "Palpitation is merely the occurrence of abnormally rapid pulsation in the heart or in the aorta, most usually the abdominal aorta,” a view perhaps all readers are not inclined to indorse. Then follows the consideration of the secondary results of heart failure, for which we are usually consulted rather than for the heart lesion itself; after which come angina pectoris, and other forms of cardiac pain, and then a lecture upon the diseases of the heart walls, pericarditis, myocarditis, and hypertrophy apart from valvular disease. We could wish Dr. Balfour to give us his views upon hypertrophy in valvular disease in the next edition, and we feel sure that he will have much that is interesting to say on this important matter. His views on the treatment of heart disease, and especially the indications for digitalis, are sound and trustworthy. Arsenic is a drug he sets great value upon. The final three lectures on malposition of the aorta simulating aneurism, and on aneurism and its treatment, are well worthy of careful perusal. The whole work is one which reflects much credit upon its author, and which firmly establishes his reputation as an authority on the important disease of which he treats. The Edinburgh School has always been famous for the number and capacity of its authorities on disease of the heart and aneurism, and among them Dr. Balfour takes a prominent if not indeed a premier position.

Sciatica, Lumbago, and Brachialgia, and their Relief and Cure by the Hypodemic Injection of Morphia. By Henry Lawson, M.D., Assistant-Physician to St. Mary's Hospital. J. and A. Churchill, 1877. Second Edition pp. 228. In this work Dr. Lawson has put clearly before the profession the advantages to be derived from the use of subcutaneous injections of morphia in the treatment of neuralgic affections. An enlarged experience corroborates what was said in the first edition. Of 180 cases, some very bad ones, in but few did this

treatment prove a failure. Dr. Lawson does not assert that this plan "cures" the neuralgia, but "the agony must be kept under so long as it exists, and while this is done by injection the patient is increasing his appetite, and by means of the iron and cod-liver oil is getting up strength, which would not be obtained if constant pain and agony existed." Dr. Lawson gives careful details of every point to be attended to. The morphia should make a perfectly clear solution in a little hot water. The needles should be of steel, and not more than half an inch in length, as longer needles have no advantage and yet possess many drawbacks. It is not desirable to go too deep with the injection. By attention to these minor matters Dr. Lawson feels sure great relief may be afforded, and a cure rendered feasible in these painful maladies.

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