A melanotic carcinoma of the eye, for instance, would next attack the glands and then the lungs, before the liver was reached. A melanotic sarcoma in the same position, would maintain no such succession of attack; the liver might be the second object.

It is, of course, impossible in a letter of this heterogeneous character, to present anything like a detailed report of several lectures; so that I must fain be content with the transmission of the novel, in the form of isolated aphorisms or the regular account of individual lectures on some specific subject, which latter shall be forwarded, if any of unusual interest occur.

Cohnheim, Virchow's first assistant, has lately received an appointment as Professor of Pathology at Kiel. His late discovery of the escape of the white corpuscles of the blood from the vessels, has excited the liveliest attention. It has appeared in the last edition of Virchow's Archives, some seventy pages. As I had the opportunity of hearing his lecture on the subject during the microscopic course of last session, I shall attempt to send you a condensed account. The white cells, which are always nearer the walls of the vessel, are observed under peculiar conditions, to become stationary and adherent; shortly after, a protrusion in the wall denotes the presence of a cell there; the wall is then ruptured and the corpuscle is seen, partly within and partly without the calibre of the capillary, after which the corpuscle escapes entirely and is connected to the vessel by a fibrous attachment, which is finally separated and the cell floats free: thus the white blood corpuscle, while still within the walls of the vessels, becomes or rather is in the lymphatics the lymph cell and in an abscess the pus cell. The fact of the identity of the three cells, is one of long acquaintance; but the identity of origin or entity, is the new development. If the discovery be verified, it will shake parts of Virchow's cellular pathology doctrine to the center.

Perhaps the finest and most systematic clinic of the session, is that of Prof. Traube, the most American of all the medical faculty. From nine to eleven every morning, the proper propedeutic or initiatory clinic; three days in the week before the whole class, and three days with a third of the class at the bedside. The old surgical clinic room of the Charite has been appropriated for the lectures before the class. The professor and patient inside a large balustrade, behind which a single long bench for the students. There are however, two galleries of similar construction above, so that a large number of students are accommodated with the additional advantages of an equally good view for

every one. Never having seen the lecturer before, illness prevented his summer course, we obtained a seat opposite the door to secure a fair opportunity for the formation of first impressions. In the mean time, we take occasion to notice that the little stand in the corner is filled with tubes and tests and divers colored litmus, the stethoscope, Traube's own, a handsome hard rubber cylinder, with movable earpiece, a small but deep concave, and an exceedingly small bell, in general use throughout the city and in the pocket of every student, the hammer and pleximeter, likewise everywhere employed, with brush and ink for marking purposes. While bewildering ourselves in a vain attempt at the solution of the enigmatical problem of forming an equal for the great minds of the place, from the dull and sleepy material around us, the double door is flung open and the procession enters. Preeeded by an attendant with two large mouthed flasks containing urine and sputa, follow four nurses carrying the patient in a handsome iron bed, with covers of spotless purity, and then the professor and his three assistants. He is of medium stature, perhaps fifty-five years of age, rather careworn, somewhat nervous look, hair cut short and combed forward like a monk, a full, prominent, penetrating eye, a recklessness of gait and a slovenliness of attire.

He is evidently master of the situation-his gait informs you that at once-you see it daily on Fourth street among that class of men who consider that they have traveled and are familiar with the movements of things. He is a man who has suffered, and yet, is scarcely a man who has much sympathy for suffering. He carries always a sober mien which is reflected over the class as he enters. A student is called into the arena-he enters without much alacrity— there are evidently some unpleasant occurrences occasionally. The professor takes his measure at once, and having induced in him the uncomfortable supposition that perhaps some portion of his attire is failing, he requests him rather abruptly to inform him the striking features of the case before him. Should he be a man of nerve, it is well, if not, there are cooler and pleasanter climates for a permanent residence. But Traube is a splendid clinician; not a symptom or a feature escapes him; every case receives the most thorough revision. He examines the patient from vertex to toe. He is a panopticist. He is a physician of the old school, animated by the fire of the new. He is right square up to the times. He has served his apprenticeship and his journeyman life as student, assistant and private docent, and has come to his position as master workman, by dint of time and toil.

The case is the Basedow disease, a most exquisite case, the enlarged thyroid, the prominent cornea, the depression of the planes of vision, the impaired movement of the levator palpebræ, the radial tension, the ventricular hypertrophy, and the general congestion of the capillaries, as evidenced by the pink hue of the skin, are all beautifully marked, and then he elicits so handsomely the nervous irritability of the disposition. He views, reviews, recapitulates, and requests a diagnosisfortunately, it was correctly given. Then follows a slight history of the disease, symptoms, differential diagnosis, prognosis, and treatment. The treatment is, roborant and tonic, quinine and iron, with the proper observance of all those hygienic measures which would quiet the excited nervous system. The treatment of Trousseau, the antiphlogistic, with digitalis, is of all the least successful. He fears that Trousseau, like many of the French physicians, actuated by a desire to be the first to describe a disease, have allowed, on many occasions, their vanity to interfere with their veracity. The etiology, he prefers to leave untouched. So many and so diametrically opposed are the alleged causes, that it is better in these days of great discoveries in physiology, to defer an attempt. That it is a disturbance of nervous centres, is but too plain; but of what character, is a question for the future. Two cases of paralysis follow, one the result of an old diphtheria, and one of syphilitic origin. In the latter case, he speaks of the importance of establishing the existence of secondary symptoms-refers in assistance thereto, to an important discovery of modern times, the glazed and shiny appearance of the post portion of the dorsum of the tongue, as revealed by the laryngoscope. The paralysis of diphtheria is always transitory. As to the relation of a brain trouble, he states that the nearer an extravasation or tumor in the brain is to the periphery, the more complete will be the paralysis, by reason of the implication of a greater number of its fibres. In the present case the complete paralysis of the facial on one side, would indicate the seat of the affection at or near the stylomastoid foramen. Age predisposes to brain affections, the inner coat of the artery thickens, or the caliber fills with fibrin. Endocarditis in its early stages, is a frequent cause of brain emboli. The existence of an embolus in the brain for more than twenty-four hours, would certainly cause paralysis. Brain affections from arterial difficulties, give no alterations in temperature. The use of opium in brain affections, to be very cautious on account of the tendency to narcotism. The Tr. Opii Benz., although one of the weakest is still one of the most dangerous.

In a subsequent lecture were presented cases of icterus and puer

peral fever. In jaundice, the yellow color of the foam of the urine is a valuable diagnostic symptom. The test for bile in the urine consists in letting fall in a deep wine glass quarter filled with nitric acid, a few drops of the suspected liquid; the play of colors, green, violet and brown, is characteristic. Treatment-mild saline cathartics, baths, &c.

Puerperal fever he divides into three forms: periphlebitic, (here rare); endo-metritic and peritonitic-the two latter often combined. (Virchow often speaks of a diphtheritic.) The occurrence of a pleuritis duplex always renders the prognosis of Feb. Puerper., exceedingly grave. He speaks of the mortality of the disease under either the tonic or expectant treatment as colossal. He is an advocate of the antiphlogistic and mercurial-the mercury by inunction, and this to be immediately discontinued on the first appearance of constitutional symptoms. He applies leeches to the abdomen freely, but allows no after bleeding.

The next hour is devoted to Frerichs. The lecture-room is always crowded, every seat taken and the aisles full. Frerichs himself is a man of very tall stature and exceedingly awkward and ungainly appearance; a face which is nearly half forehead and almost juvenile in expression. He is also far past bodily prime, though still in highest mental vigor; a large, full eye, face perfectly smooth, mouth just a little sensual. He is a man who combines some of the pleasures of life with its pains. Although having occupied a public position for many years, and extended his travels in foreign lands, he is still a man of exceeding diffidence. It is easy to conceive what actual misery it must have cost him before he arrived at even his present posision. He sits on the corner of a table to lecture, and in the interval of its removal for the presentation of a new case, appears in the greatest embarrassment. His hands are in the way and so are his feet. Once seat him, however, and give him material, and he forgets himself completely. He is then in the full possession of the medical sang froid. His every word is treasured, for it is the result of years of the ripest experience. His voice is a deep bass, in slow and measured tones, beginning a sentence with a slight elevation and gradually fading off to a sound almost inaudible. Heard for the first time at the back part of the room, it only requires the solemn intonations of an old organ to remind one of the service of the old Baptist church. But it becomes even agreeable in time, presented as it is, with the full ore rotundo, in sentences pregnant with richest import, axioms as it were, it is easy to understand the secret of his success. Here, also, every facility for

explanation and illustration exists. The microscopes are placed on the stands, while drawings and specimens are passed around the class. The perfect nonchalance with which he pricks the finger of a patient to ascertain if the drop under the microscope evidence a simple anæmia or a leucocythemia, is a matter of at least surprise to the uninitiated. Every attempt to improve the blood in the latter condition, he informs us has hitherto proven futile, hence the importance of a proper diagnosis. To exhibit the peristaltic movements of the stomach in a case of carcinomatons stenosis of the pylorus, whereby the organ was enormously displaced and in proof that the tumor below the umbilicus was really the distended stomach, he administered a carbonate, followed by an acidulated drink; the effect was almost instantaneous, the movements of the walls under the attenuated integument being palpable to all.

The length of this letter already totally precludes any attempt at a report of further procedures, which I may, perhaps, transmit in a WHITTAKER. future letter.

NEW YORK CITY, DECEMBER 15, 1868.

DEAR JOURNAL: When last we wrote, the sessions at the different medical colleges of this city were about commencing. Now, the lectures are nearly one-half over, and the lecturers are looking forward, with pleasure, to a short period of repose during the approaching holidays. While the students will hail them no less eagerly, as a golden opportunity for writing the dreaded and long-thought-of thesis. If they only knew, as do we who have passed through the mill, how often the thesis that has cost so much labor and so many wakeful nights, is neglected and packed away without ever having been read, they would not feel so much anxiety about it. A thesis does not amount to much, at any rate, in these days, when they can be bought by the dozen in almost any second-hand book store; nor, in fact, does an examination, for too often the poor student, on these awful occasions, has frightened out of him the little that he does know. The system of daily recitations, so often urged in our medical journals, seems to us the most feasible way of ascertaining the true status of the student's acquirements, and it is certainly a most improving and instructive method of driving home the great truths to which the student is daily listening. The system of daily quizzes, is now an established institution in our city colleges, and one from which the inquirer after medical knowledge