leading, assuming that it is entirely an imaginary case, and that there is no reference whatever to the prisoner. I should not be willing to give an opinion that it really represented an insane man. The element in regard to heredity does not state whether it was heredity in the direct line or simply collateral. A man may have parents or other relatives insane, and not be insane himself. Such transmission may not go to him at all. In regard to the second proposition, as the question is stated, there is no foundation except the opinion of other persons that he was insane; and I should not be willing under oath to give an opinion as to the possible insanity of a person on the opinion of others, especially without knowing whether the observers who made that opinion were competent persons to observe. In regard to the third element which this question presents, of the possibility of an insane delusion in the case as inferred from the word ' inspiration introduced, there is no statement in connection with it as to any disease. The motive given is a love of country, and, taken in its literal sense or reasonable sense, together with the conclusion as to the conduct of the person after the act, my judgment would be that it would not represent an insane person. It suggests a person who is dominated by his own idea that he is inspired by God to remove the President for the love of his country. If inspiration is an insane delusion then the person would be insane without reference to anything else; but if it is only inspiration and interpreted as such, it is then, as I understand, only an illumination of his mind by God as the source of all truth, so that he sees it to be his duty to remove a ruler; and in the further development it states that this amounted to a belief that it would be in accordance with the divine will to have this done. In the further development of the question, though it is stated as in the nature of a command of God, it is qualified by the expression afterward to the extent that it was a conviction, not to the extent that it was a command, because the command is qualified by the statement that it was a conviction overriding the force of his conscience and will. Finally it is stated that he was unable to withstand the mental pressure, not any divine pressure, but mental pressure. If mental pressure means anything, it means reflection, thought, judgment.

66

Then if you take into consideration the fact that at the conclusion he simply felt like one who had discharged a duty to his country, you have, as I conceive, no possible indication of insanity; but it may be fanaticism. On the other hand, if it was inspiration, which is to be taken in this case as an insane delusion, then the conclusion that he had felt as though he had performed a duty when he was acting under the command of God, and that was the end of it, that it really arose with the occasion of the

idea, and closed with the accomplishment of the act, is entirely inconsistent with any idea of insanity."

The question will naturally arise, Why was I especially singled out as the target for Mr. Scoville's abuse? and the answer is simple: I was the only one of the experts summoned for the defence, who, believing in the sanity of the prisoner, and placed on the witness-stand by Mr. Scoville, who was cognizant of that belief, refused to stultify myself or prove false to my oath, and was then retained as expert by the government. Those gentlemen who answered the question as desired were not detained any further.

I will now consider the leading events in the life of Guiteau, including the incidents attending the murder, and show how inadequately they bear out the theory of insanity.

(To be continued.)

OCCIPITO-SACRAL POSITION: CASE IN PRACTICE.

BY PERRY MARSHALL, M. D., WEST ADDISON, Vt.

It is said that of 20,517 deliveries, this position occurred but twice, and some accoucheurs doubt its existence. [Boivin.] (King.)

I was summoned March 2, about 1 o'clock, P. M., to the bedside of Mrs. S—, aged thirty-three years. Found her in her first labor, first stage; the os-uteri somewhat rigid and undilated, the diameter of the orifice being not more than two lines. I retired until daylight, when examination revealed dilatation enough to admit the point of the finger, the pains continuing at somewhat regular intervals. Gave Tinct. Belladonna gtt. v. At noon, the os would admit two fingers, and I was sure of a vertex presentation. Applied Unguentum Belladonna to the os, and cloths saturated with lobelia water over the abdomen. Dilatation was complete about six o'clock, P. M. Examination proved the head to be in the occipito-sacral position; the sagittal suture running antero-posteriorly; the flat surface of the top of the head forming a floor across the upper strait. The forehead could be felt distinctly above the pubis. The pains. were quite regular and natural; but effected nothing except to turn the head to the right occipito-posterior position, with partial flexion and very little descent in two hours. I assured myself positively of the position by introducing my hand so far as to reach the fingers around the occiput, which lay at the right of the sacrum.

Introducing one blade of the forceps to the mother's left, and lifting gently but firmly, the rotation toward the right occipitoanterior position was partly accomplished. Being a ster

to the patient, and not enjoying the fullest confidence of the family, and not able to deliver at once, I sent for Dr. B- who arrived in about two hours, during which time the patient continued free from any severe pain, and enjoyed partial rest between pains. No examination during that time. Patient had taken during the evening Tinct. Cimicifuga, fifteen drops two or three times, as the pains were not deemed sufficently vigorous. I like the Cimicifuga, too, for its calming effects.

On arrival of Dr. B—, we found that the head had rotated to the right occipito-anterior position, the patient in good condition, skin moist, pulse strong, etc.; but the stoutest pains were not sufficient to effect the slightest descent. Dr. B- then applied the forceps, and delivery was effected in about twenty minutes, twenty-two hours after my first arrival.

The delivery was very painful on account of a little contraction, transversely, of the lower strait.

I am sorry to say that the perinæum was somewhat lacerated, requiring two sutures. The placenta soon followed. There was but little hemorrhage, and the patient made a good recovery.

MARCH 14, 1882.

BOSTON HOMEOPATHIC MEDICAL SOCIETY.

REPORTED BY FRED. B. PERCY, M. D., SECRETARY.

THE regular monthly meeting of the society was held at the college building, Thursday evening, March 9, 1882. Dr. Chamberlin of Worcester, Dr. Whittier of Fitchburg, and Dr. French of Lawrence, were the invited guests of the evening. The censors reported favorably on the names of Fred. A. Freeman, M. D., and Charles Leeds, M. D., and they were elected. The following were proposed for membership: William G. Hanson, M. D., Everett; L. A. Philipps, M. D., Boston. The election of officers resulted in the choice of H. C. Clapp, M. D., for president, and Benjamin T. Church, M. D., for vice-president.

Most unfortunately, three of the four physicians who had promised papers on the subject under discussion for the evening were unavoidably detained, greatly to the disappointment of the many members present.

The paper by E. B. de Gersdorff, M. D., on the "Etiology of Diphtheria," was a most interesting and instructive one, which we can only briefly summarize. Diphtheria is a general zymotic disease, infectious and contagious, though its main hearth of development is the throat. There are four forms of the disease: first, second, fibrinous; third, septic; fourth, cy to decomposition of the blood,

uræmia, etc., is common to all forms. According to Virchow, diphtheritic products are of heterogeneous nature. In considering the etiology of this disease two important questions arise:

First, In what relation stand the general and local symptoms? Is the disease primarily general and secondarily local, or vice versa? Does it infect the system from diphtheritic patches? Pathological experiments show that each inoculation, no matter where made, is followed by membrane and then general constitutional symptoms. The contagium is carried through the air, retained in carpets, clothing, paper, etc.

Second question: Whether occurrence of vegetable fungi is an accidental or conditional event? These fungi will always produce fatal disease if inoculated upon any mucous surface. Primary infection is due to vegetable fungi floating in the air. Sporadic cases do occur, but this is true of scarlet fever, etc. Poor traps,

defective pipes, decomposing vegetable matter, water, and atmospheric agencies were mentioned as potent causes of the disease. Among preventive measures he spoke of good air, especially in sleeping-rooms, keeping away from newly opened ground, new cellars, etc.

Owing to the absence of the other speakers, the subject was opened for discussion. Dr. Chamberlin, of Worcester, said that when we had lung complications, crusty sputa, etc., he would recommend Hypophosphite of Potash, two or three grains to an ounce of water, as inhalation, using steam atomizer for this purpose. With Bell., Actaa racemosa, and Merc. biniod. 2, internally, he combated most cases, though Lach., in high potency, had done good service in some cases. Good pure air and plenty of it was absolutely necessary.

Dr. Whittier, of Fitchburg, said he thought nature would look out for the simple form. In other forms he thought the proper remedy and nutrition were two important factors. His remedy was Kali bich., 2c or 3c. As adjuvant he used alcohol and water, as spray or gargle; milk ad libitum, even in a febrile stage; also oysters, beef tea, and other things, if particularly craved, he advised.

Dr. French said he had studied with a great deal of interest the etiology of the disease, but was often puzzled. He cited a case then under treatment in which the cause of the disease was not apparent.

Dr. de Gersdorff said he must speak a good word for the mineral acids in the treatment of this disease, for in his hands they had done much good: notably Sulphuric and Muriatic acid.

Drs. Sherman, Leslie, and Woodvine also took part in the discussion, and the meeting adjourned at ten P. M.

REVIEWS AND NOTICES

OF BOOKS.

HOLMES'S SYSTEM OF SURGERY AMERICANIZED. Vol. III. Philadelphia: Henry C. Lea's Son & Co. 1881. pp. 1059.

In two or three numbers of last year the GAZETTE called attention to this magnificent work; and now that the third volume has appeared, we think that the unanimous verdict of the profession must be that the American publishers have quite fulfilled the promises made in their original prospectus. This, the last volume, contains articles on diphtheria, croup, and apnoea; on diseases of the larynx, thyroid gland, breast, skin, bones, joints, spine, muscles, and nervous system; on orthopedic surgery, and gunshot wounds, anæsthetics, amputation, plastic surgery, minor surgery, parasites, venomous insects and reptiles, surgical diseases of childhood, surgical diagnosis and regional surgery, and on hospitals. The two sections in this volume which will be found to differ most from the English edition are those on skin diseases and anaesthetics, which have been mostly rewritten. We are pleased to see that the superiority of ether to chloroform, on the score of safety, is stoutly maintained, although perhaps not so much so as if the reviser had been a Bostonian. Public opinion on this subject has changed a great deal, even in England, within the past few years. It is impossible within our limits to give anything like a complete review of this great work. Confining ourselves to generalities, we can assert without exaggeration that this is by far the most comprehensive, exhaustive, cheapest (for the amount of material), and in fact the best treatise on surgery ever yet published. We congratulate the thirty able American surgeons who have so well succeeded, each in his own special department, in making such a careful, thorough, and searching revision of such a masterpiece, and in adapting it to the wants and practice of this country; and we advise each one of our readers, whether they ever do any surgery or not, to invest eighteen dollars in a standard work, which cannot fail at some time to be of great assistance.

T DISEASES OF THE EYE. By Henry D. Noyes, A. M., M. D. New York: Wm. Wood & Co. December, 1881.

This recent contribution to ophthalmic science is the latest of "Wood's Library of Standard Medical Authors." The subject has been of necessity limited, but the author has done his work very thoroughly. He has not confined himself to the results of labor of others, but has contributed much from his own experience, that is of value. He has devoted Part I. to disturbances