work done in the Charité; and thus undertake the proper function of hospital reports, the recording of observations made within the walls of the building.

The remark of the Frenchman upon an Arabic book, Ce livreci commence à la fin, applies in this case; for beyond all doubt the most important article is the last in the volume, that contributed by Virchow. It is most desirable that so experienced a morbid anatomist should leave on record his method of making examinations after death. Even though some of the details may not be approved by all, yet the general rules are most excellent. Among them may especially be commended that which insists upon the importance of following a certain order, a constant method, in the examination. There are of course some cases in which an exception to this rule must be made, but care should be taken not to make the exceptions become the rule. The best guide when and how to make the exceptions will be a knowledge of the reasons upon which the rules are based. Virchow instances the rule for taking off the calvaria: generally it comes away from the dura mater without trouble; but in children and some grown-up persons the calvaria is so glued to the dura mater that both have to be removed together. In this case the brain of the infant would be destroyed if a foolish adherence to general rules were persisted in.

The rules for the examination of the brain, spleen, lungs, and liver are exceedingly good. If there be one point open to criticism, it is the direction that the bowels should be removed from the belly last of all, and this chiefly on account of the trouble which the morbid anatomist must have in hindering their contents from being spilt upon the remaining viscera, the table, the body, and even the persons of the bystanders. Now for several years past it has almost daily been our custom to remove the bowels as soon as the examination of the chest and of the spleen had been completed; and in no case, save where a very unexperienced person was employed, has there been any trouble as regards the escape of the fæces. There is this great advantage in taking out first the large and small intestine, that the kidneys in position with their vessels and ureters are left for a further anatomical examination, and a leisurely dissection may be made of them; all this is utterly destroyed if the kidneys be taken out before the bowels, as we have seen commonly practised in Berlin.

Dr. W. Zuelzer gives an article with observations on the excretion of phosphoric acid in the urine in pyrexial diseases. Eleven cases are recorded, the amount of urea and phosphoric acid at varying periods and varying temperatures of the disease are added together, with the amount of the whole, and the ratio of the nitrogen to the phosphoric acid calculated from

these data; that the nitrogen is to the phosphoric acid as 100: 13.5. This recalls the worst days of Louis, but we are glad to see that the writer is not satisfied with this mere collection of figures, but adds a few remarks to show that during the pyrexia a less amount of phosphoric acid is excreted in proportion to the nitrogen. The writer does not seem to have been acquainted with Dr. Gee's interesting observations, which show that the phosphoric acid entirely disappears from the urine of ague during the acme of the paroxysm. The amount of phosphoric acid during convalescence seems according to Luelzer to be much increased.

A report of the midwifery department is sent by Dr. Beinlich, the statistics of which are given in a very full and complete manner. As might be expected, only one-tenth of the women delivered were married. Nearly one half (476 out of 995) were between the ages of 20 and 25. Ten women were brought to bed between the ages of 40 and 45; and, positively, one woman, a widow, at the age of 51. The statistics of the various presentations are carefully given, and the number of times that operative interference, or the like, was needed are stated at length; and the paper ends with a table of weights and anomalies of the fœtus, and the number of deaths in child-bed, which gives about 4.5 per cent. in this department of the Charité.

Lewin gives a statistical account of the venereal affections treated in the Charité under the heads of gonorrhoea, soft chancre, and hard chancre. At the end of his article he discusses the question whether circumcision would be useful in guarding against disorders of this kind. He comes to the conclusion that it would not, but for the reasons we must refer the reader to the original article. A case of parasitic sycosis and a case of persistent arteria hyaloidea are also given.

Henoch, so well known amongst the writers on children's diseases and diseases of the belly reports upon the statistics of the children's department. Out of 633 children, 246 died, and this enormous mortality is, as may be looked for, caused entirely by the deaths of infants of tender age. Out of 177 children under six months 133 died, and the percentage continues very high until the third year is reached. This statement may serve to throw light upon the high mortality lately noticed in a charitable institution in Carlisle Place, and to show that even when all the appliances which science can suggest are at hand, there is nothing to make up for the lack of the mother's care and devotion which Nature has clearly made necessary for the well-being of infants. Nothing would be a greater failure in practice than Sir Thomas More's scheme for the bringing up of children in Utopia.

Scheweigger says a few words on the ophthalmic operations for cataract, of iridectomy, and for squint.

Some observations from Traube's clinical wards also are given

and Joseph Meyer offers some important clinical observations upon the percussion of the spleen; for this the observer strongly recommends the hammer rather than the fingers.

Eichhorst details at length some rare cases of diseases of the nervous system. The first is one of hæmorrhage into the spinal chord, attended, as Eichhorst insists, by diseases of the bloodvessels, and in this case caused by miliary aneurysms. He describes also a case of syphilitic disease of the basilar artery and consequent softening of the pons varolii, and several cases of involuntary movements of the limbs and disease of the brain.

Ewald reviews the various arguments for and against operative interference in pleurisy, the various instruments to be used and the method of using them. In simple pleurisy he approves of the rule not to operate before the end of the fourth week, unless indeed some danger to life arise; in the first case the operation may be done without hesitation. From January 1, 1860, to June 1, 1875 there were 250 cases of pleurisy treated in the Charité. Thirty of these died. Two hundred and four were cases of simple pleurisy: 200 were tapped and not one did ill. The four which were not tapped died from compression of the lung and bronchitis and peribronchitis. The others were cases of empyema, and in these the mortality was high, more than one half, whether tapped or not, dying.

In taking leave of this number we cannot do better than recommend it to the notice of our readers; and we wish it all the success that has fallen to its older and longer established contemporaries.

A Course of Operative Surgery with Plates drawn from Nature. By CHRISTOPHER HEATH, F.R.C.S. London: Churchill.

WE confess this work has disappointed us. Its author deservedly ranks high among practical surgeons, and he has an equally well-earned reputation as a surgical anatomist. He has taken the trouble to have various operations depicted by means of coloured plates, "drawn from nature." The result does not equal the anticipations we had formed. To speak first of the plates. Mr. Heath tells us they were drawn from operations he performed on the dead subject. But for this assurance, we should have thought they were drawn by an artist guiltless of any knowledge of anatomy, and who had been left very much to his own devices. For instance, Fig. 1, b, in Plate IV. represents the incision for ligature of the third part of the subclavian artery. This is placed so that nearly the whole width of the clavicular part of the sterno-mastoid is exposed. Fig. 1, a, certainly does not convey to the mind of the student an accurate idea of the relation of the axillary vein and brachial plexus to the axillary artery. The vein almost invariably overlaps the

artery, and both it and the plexus are on a plane anterior to it. In Plate VI., Fig. 1, the incisions for ligature of the common iliac artery and for strangulated femoral hernia are much too short, and neither, so far as we understand the drawing, is exactly where it should be. Plate VIII., Fig. 1, puts the incision for tying the posterior tibial artery at the ankle, exactly over the tip of the internal malleolus. Plate X., Fig. 6, is drawn to show a foreign body in the œsophagus, but undoubtedly the body is depicted in the pharynx; for it bulges at the level of the thyroid cartilage where it might be reached, and extracted through the mouth. Plate XII., Fig. 1, represents the incision for lateral lithotomy. The drawing is altogether "out of drawing," the incision is too far forwards, and its lower end seems, as far as we can judge, to pass well into the thigh. We do not think that Mr. Heath himself cuts with such a knife as that drawn in Fig. 2. In Fig. 3 the operator seems to have succeeded in firmly grasping his own finger. Even in the letterpress, for which Mr. Heath is entirely responsible, are to be found more inaccuracies than should be permitted in a work of this kind. Thus at p. 14 we are told the ulnar artery lies on the flexor sublimis digitorum, and, lower down, the fore-arm is called the arm. At p. 25 we are taught that in removing the breast, if disease has involved the pectoralis major, "it may be necessary to remove nearly the entire muscle." No doubt the writer means "< the entire thickness of the muscle." In giving the anatomy of the external iliac artery (before the common has been described) the author says "it extends from the bifurcation of the common iliac artery to Poupart's ligament": but he gives here no point at which the bifurcation occurs; nor any spot in the length of the ligament towards which the vessel runs; and he makes no mention of the deep circumflex iliac vein, as crossing the artery just before its termination. Many of these may seem small matters to be critical about; but we refer to them because they indicate, when coupled with the defects we have mentioned in the plates, a certain degree of looseness and carelessness where accuracy and painstaking were above all things necessary. We have spoken thus freely of this instalment of Mr. Heath's work in the hope that in the succeeding numbers the defects we have pointed out may be avoided.

Clinic of the Month.

A New Saw. Mr. F. A. Stohlmann has invented an entirely novel saw, which is now made by Messrs. Tiemann, of New York. It is intended to replace the chain saw in common use, and is entirely free from the tendency to bind, kink, and break, which characterises the latter instrument. It consists of two handles, connected by a wire of cast-steel, on which are strung a series of steel beads with sharp cutting edges. The instrument might indeed be called a file, quite as appropriately as a saw, and its action on a bone is said to be more like that of the firstmentioned tool, in the absence of such rough edges as are made by the saw in common use: no needle is required to carry it through or round a bone, and its beads can be readily strung on to a new wire in case of a break. Another advantage lies in the fact that the beads by their free rotation present fresh cutting edges; and still another is the considerable difference in price between this instrument and the ordinary chain-saw. (Medical Press and Circular, March 28, 1877.)

The Relation of Alcoholism to Uterine Disease.Dr. Doyle read a paper on this subject before the Dublin Obstetrical Society, the object of which was to show that the habit of taking alcoholic stimulants by females with ample means frequently depended on a diseased condition of the uterus, and that by curing it, the cause being removed, they gave up using stimulants, as was proved by cases he recorded. Another case recorded by Dr. Doyle showed that when alcoholic drinks are taken to appease a depraved appetite, they did not produce a disease of the uterus, except as in the case in question, a congestion depending on a mechanical cause from enlarged liver. Although not disapproving of the use of alcoholic beverages in moderation, or when ordered medicinally, he avoids prescribing them as much as possible, and substitutes in such cases as need them a mixture containing sp. vin. rect. with sp. ammon. aromat. or tinct. digitalis. In the discussion that followed the reading of the paper various speakers, as Dr. Denham, Dr. McClintock, and Dr. Kidd, expressed the opinion