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" 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 great majority apparently being of the dates between 1840-1850; 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.

CORRESPONDENCE.

A CASE OF ACUTE BRIGHT'S DISEASE-WITH URÆMIC CONVULSIONS AND COMA.

Messrs. Editors North Carolina Medical Journal:

She

Ou July 1st, 1890, was brought to my office a white girl, 11 years old, with a good family history and previously good health. was stout and heavy for one of her age. For only a couple of days prior to her visit to me there had been noticed a slight swelling of the feet and ankles, with puffiness of the lower lids. There were no subjective symptoms.

I diagnosed kidney trouble and put her on a diuretic plan of

treatment.

On July 5th I called to see her at her home, a distance of three miles in the country. Found her up, bright and cheerful, but swelling of lower extremities and puffiness of face very little improved, though there has been an increase in the amount of urine voided per diem since her visit to my office.

On July 8th was hastily summoned to find her in convulsions. She had three spasms, with intervals of two and a half to three hours, at which time all the voluntary muscles were promptly convulsed-bloody froth appearing at the mouth. Convulsions lasted from two to four minutes. These muscular twitchings lasted for six hours, after last convulsion, and she rapidly passed into coma· That was on the evening of 8th of July, and she remained perfectly insensible to any external irritation-hearing not, seeing not, tasting not, feeling not, speaking not, until the evening of 14th of July, when she opened her eyes and spoke for the first time in six days and nights.

To control the convulsions I used often repeated hypodermics of morphine, and occasionally, during the coma, I administered small hypodermic doses.

To reestablish the suppressed renal function, I used infusion digitalis in large doses-3 iv. every three hours-by enema, as it was impossible to administer by the mouth. Also used dry and wet cupping over the loins.

For the sake of diaphoresis, I used the hot pack. The effects shortly following the administration of these remedies gave me hope and courage to persevere in the plan of treatment which saved my patient.

The "plan" is, I believe, the routine of the profession in regard to these cases, with one important exception-the hypodermic injection of morphine.

Morphine thus administered not only controls muscular spasms, but becomes a powerful eliminating agent, as it facilitates the action of cathartics and diuretics, especially the diuretic action of digitalis (Loomis), and reestablishes a diaphoresis which is sometimes profuse. The object in calling attention to this remarkable case is to speak earnestly in favor of the free use of morphine, hypodermically administered, in all cases of uræmic convulsions.

Most of the authors only speak of morphine, in such cases, to guard against its use. Blessed be the few that recommend it, and their names shall not be forgotten in the land." Specific gravity urine during first days of sickness was from 1.028 to 1.030; was very albuminous, and contained blood and epithelial casts. Milk, by enema, was the form and mode of nourishment administered during the prolonged coma. The patient was kept in a large well ventilated room from beginning to complete recovery.

The digitalis was withdrawn as soon as diuresis was established, and the free use of diluent drinks substituted. It is a great pleasure to add that the recovery of my little patient is complete, there being no evidence of permanent impairment of the kidneys.

E. F. STRICKLAND, M.D., Bethania, N. C.

UNUSUAL PROCEEDING IN A SEVERE CASE OF ABORTION.

Messrs. Editors North Carolina Medical Journal:

In an experience of above a third of a century I have not met with a case death from abortion nor from its immediate effect; but I am persuaded that by deviating from well-established principles in the following case, while I ran the risk of causing the patient's death from septic poisoning, I actually saved her life.