The time may come when the theory of expert testimony, viz: that all doctors qualified to practice medicine are necessarily experts in all the branches they have to practice, but it is not so at present. We enter here a mild protest against physicians allowing themselves to be called experts, when they are not, when such an opinion of their qualifications could only be determined by a committee of their professional peers after an examination, or some more positive knowledge of their abilities. It is really a delicate question for one to decide for himself.

Finally, it would advance expert testimony and opinions, if, instead of the expert being summoned by the counsel in the case, for the selection to be made by the judge, after carefully obtaining the opinion of the medical profession as to the qualifications expected in a given case. This latter thought may be entirely Eutopian, but it is not wider the mark than the present assumption of the graduated qualifications of all doctors as experts on all medical questions. T. F. W.

ARSENICAL MELANOSIS.-Professor Wyss (Correspondenzblatt f Schweizer Aerzte, 1890, No. 15) relates the case of a girl of 12 and a boy of 10, who were treated for chorea with 1 : 2 Fowler's solution. After a daily dose of 45 drops of the solution had been reachsd, a general, dirty-brown pigmentation appeared over the whole body. This disappeared on discontinuing the arsenic, but it recurred again in the case of the girl when the arsenical course was resumed. Portions from the skin of one of these patients and from another case were examined microscopically. In earlier cases the granular coloring matter was deposited in the lymph channels in the papillæ, and to a less extent in the cutis. In older cases, on the other hand, the deposit took place in thick clusters in the widened plexures of the lymph vessels of the cutis. Attempts were made to ascertain the condition of the cutis, but no positive results were obtained. Professor Wyss is of opinion that a considerable decrease in the number of blood-corpuscles and in the amount of hæmoglobin occurs after the use of arsenic; that arsenic, when absorbed in sufficient quantity, disturbs a great number of bloodcorpuscles, and partly displaces the hæmoglobin, and the decomposed blood pigment reaches the lymph channels of the skin in an insoluble granular form, where, if the deposit be sufficient, it produces arsenical melanosis.-Sup, to the Brit, Med. Jour.

REVIEWS AND BOOK NOTICES.

A MANUAL OF MODERN SURGERY: An Exposition of the Accepted Doctrines and Approved Operative Procedures of the Present Time for the Use of Students and Practitioners. By John B. Roberts, A.M., M.D. Philadelphia: Lea Brothers & Co., 1890. This is a very compact octavo volume of about 800 pages, offered as a practical text-book on the Science and Art of Surgery as it now exists, for the profession, fully conscious that the lapse of a few months only, adds much to our substantial knowledge of surgery, never weary of a fresh volume on the subject; and when this volume comes from the pen of one who has been for some time a contributor to the journals upon the advance methods, and who is a teacher of this branch, they are disposed to receive such a volume with favor.

There is nothing noteworthy in the arrangement of the subjects, nor is there special need that the teacher should deviate from old arrangements of matter, as book-readers are facilitated in consultation by the conventional enunciation of the principles of inflammation, inflammatory processes, erysipelas, scrofula and tuberculosis, syphilis, rickets and rachitis, tumors, wounds and shock, method of repair of wounds, practical surgery and anesthesia, etc., etc.

At every point the writer gives a practical turn, wasting very little time and space in discussing mooted questions. The subject of Anesthesia is compassed in four pages, but is written with less bias than is usual in similar works by Philadelphia authors. The author enunciates the following:

*

*

"Anesthesia is always a dangerous condition, and requires the undivided attention of an experienced assistant. Death has occurred not infrequently from etherization and often from chloroform anesthesia." "The semi-recumbent or sitting position is not justifiable during chloroform inhalation. In operations upon the nose and palate it is often better to have the patient lying on his back with the head so bent backward that the palate is lower than the floor of the mouth. Blood is thus kept away from the site of the operation, and yet does not flow into the larynx, causing choking and coughing."

The minute directions given for anesthesia are applicable to the use of ether, but contain many hints that an old anesthetizer can get some excellent points.

"The principles or fundamental laws" which the author lays down for operative surgery are good and will bear transcription: 1. Obtain the services of an etherizer who will not require you to superintend the anesthetic.

2. Take precautions to prevent hæmorrhage, if the locality renders this possible.

3. After proper thought and consultation have the plan of operation clearly outlined in your own mind.

4. Have the patient, the instruments, yourself and your assistants absolutely aseptic.

5. Proceed systematically with the steps of the operation decided upon, and do not be led into a mixed operation by bystanders, unless unexpected developments in diagnosis occur.

6. Attack the greatest difficulties and dangers of the operation first.

7. Do not stop to tie any except large vessels, but let assistants apply hæmostatic forceps, or make pressure with their fingers until incisions are completed.

8. When the operation is finished stop hæmorrhage and apply dressings.

9. Finally, remember that suppuration in an operation wound is usually, probably always, due to careless asepsis on the part of the surgeon or his assistants, except in those instances where the operation is done on tissues already suppurating." Simple enough are the above, but not always remembered by those who do not have considerable surgical practice.

The points we have examined with the most interest in this volume, causing us to scrutinize them quite carefully, have given great satisfaction.

The author has succeeded in giving a symmetrical view of all the subjects, so that the student who is for the first time receiving instruction in the elements, and the doctor whose mixed practice. leads him to consult a special chapter, are equally safe.

Small as this volume appears in comparison with the encyclopediac works we are accustomed to, it has not slighted any of the depart. ments of surgery, except that of the eye and ear, but they are

branches which have long since outgrown works on general surgery.

The illustrations are numerous, comprising many of the venerable stock figures of the surgeries of the past, classical and appropriate, but there are many new ones, and we can complain of no lack of pictorial aid.

We feel assured that this is a substantial text-book, condensed, lucid, practical, and will take its place with the best now accessible to the student.

INDEX-CATALOGUE OF THE LIBRARY OF THE SURGEON GENERAL'S Office, United States Army. Authors and Subjects, Vol. XI. PHEODRONUS-RÉGENT. Washington: Government Printing Office, 1890, 4to., pp. 1102.

The appearance of the 11th volume of this great work, reaching only "Régent," indicates that the work will probably reach two or three more volumes before it is finished, and then a supplement will probably be a necessity. The Government makes no investment which is more honestly administered than the sum appropriated to the preparation and issue of these volumes, and probably no volumes have given our Government more reputation for liberality and scientific spirit than they have. The typographical merits of the Index-Catalogue we have written about before, but one must be familiar with the volumes as aids in library work before he can fully appreciate the excellence of the arrangement, the variety of type as helps to the detection of the item in quest, the clearness of the impression, and the wonderful freedom from typographical

errors.

The subjects "PHARMACOPEIA "PHARMACOPEIA" and "PHARMACY" include a large number of items, extending over 58 double column pages; PHRENOLOGY, the dead art, has a literature comprised in 11 columns. with now and then an item as far down as the eighties, the majority apparently being of the dates between 184 PHTHISIS, remaining at this date by far the most interesting and important disease of the age, has an enormous literature past and present contained in 358 columns; in 42 columns are arrayed all that physicians have said about physicians, a formidable array; 80 columns are devoted to PHYSIOLOGY; 50 columns include the items on PLEURA and PLEURISY; PNEUMONIA, as would be expected, has

110 columns devoted to it; PREGNANCY Covers a space third in extent to that of Phthisis, filling 126 colums; PтOMAÏNES, a comparatively recent subject, the very large majority of which are of this decade, reaches the surprising space of 64 columns; PUERPERAL has items enough in volumes, pamphlets, medical journal articles enough for 150 columns; QUACKS and QUACKERY take up 14 columns; 33 columns are devoted to QUARANTINE; 28 columns to QUININE; the RECTUM gets 66 columns. These few items give a slight idea of the vast number of volumes and treatises written upon such subjects as are mentioned; the Index-Catalogue makes all these available to the student-physician, under certain rules. THE ESSENTIALS OF MEDICAL CHEMISTRY AND URINALYSIS. By Samuel Woody, A.M., M.D. Third Edition. Philadelphia:

P. Blakiston Son & Co., 1012 Walnut St., 1890.

This book, in its previous editions, has met with favor. In urinalysis it isnot up to the latest knowledge of the subject.

HEREDITARY ATAXY AND ATROPHY OF THE CEREBELLUM.— Menzel (Arch. f. Psych., Bd. xxii, H.I.S. 160) records the case of a man with a strong neurotic family history, who died at the age of 46. From the age of 6 years uncertainty of movement had slowly supervened, and at last he could not walk, write, or follow his occupation. The case was diagnosed as one of Friedreich's disease. At the necropsy it was found that there was most marked atrophy of the cerebellum. The microscope showed the following changes in the spinal cord: In the lumbar region atrophy of the cells of the anterior cornua and of the anterior roots, degeneration of the posterior columns and posterior roots; in the dorsal and cervical regions degeneration of Goll's, Burdach's, the pyramidal, and the cereballar tracts. These degenerations extended up into the medulla.-Supplement to the British Medical Journal.