several of these various forms of variola or varioloid, and then briefly to note the complications of the disease, after which he gives a well written sketch of its morbid anatomy.

The difficulty of early diagnosis, and the liability to confound the disease with syphilitic eruptions and acne pustulosa, are fully recognized, although no reference is made to a possible source of doubt which might occur in the eruption sometimes observed to follow the use of balsam copaiba, and which has been actually diagnosed as that of variola. "One pathognomonic symptom" is indicated, although "present only in the smaller number of patients. It consists in the hæmorrhagic initial exanthema, situated principally in the triangle of the thigh.'

The mortality from small-pox is said to have diminished, since the last century, from 7 to 12 to 0.7 to 1 per cent. of the total.

As a prophylactic, the author's confidence in vaccination is thorough; but he has no confidence in its protective capacity when performed during the stage of incubation. Abundant evidence exists on this side of the ocean to demonstrate that the protective power of vaccination is efficient even during this period of incubation. The possibility of securing this protecting influence is suggested by the difference in the length of the period of incubation of the two diseases, that of vaccinia being two, while that of variola is generally from "ten to thirteen days." This suggestion has been practically and successfully acted upon so often as to leave no room for doubt upon the subject. The author's ideas on the subject of treatment are rational and judicious. He does not try to "cure the disease," but to keep the patient alive, and as comfortable as possible under the circumstances, and has no faith in efforts at abortion either of the disease or the eruption.

The discovery of vaccination is, justly, assigned to Jenner, and his merit is by no means diminished by the pre-existence of the knowledge that persons who

had contracted the vaccine disease enjoyed an immunity against small-pox. This fact constituted the essential premise of Jenner's induction, without which it could not have been made.

The origin of vaccinia is attributed to a similar disease occurring in horses, and the existence of manifestations of the same character in other animals susceptible of intercommunication, is asserted.

Dr. Curschman dissents from the belief in the deterioration of humanized vaccine, and perceives no advantages in the use of non-humanized virus. He is very justly skeptical concerning the transmission of constitutional diseases, more especially syphilis, by vaccination, and with equal justice attributes the very rare instances in which such results have occurred, to carelessness in the selection of the subject and of the lymph, and in the performance of the operation. He is a warm advocate of compulsory vaccination by State interference-a proposal which presents to Americans two phases so strikingly contrasted as to necessitate great deliberation in its adoption or rejection. The subject of re-vaccination is entirely ignored, except incidentally.

Taken altogether, Dr. Curschman's article is an excellent compendium of the state of knowledge upon the subject of which it treats, and will constitute a very useful work for the general practitioner.

H.

ESSAYS ON CONSERVATIVE MEDICINE AND KINDRED TOPICS. By Austin Flint, M.D., Professor of the Principles and Practice of Medicine and of Clinical Medicine, in Bellevue Hospital Medical College, New York. Philadelphia: Henry C. Lea. 1874.

Prof. Flint's name has been so thoroughly identified with conservatism, that it appears with peculiar propriety upon the title page of a volume devoted to its exposition. And the presentation of the thoughts and opinions of so accomplished a physician and so ripe a scholar, in this form, is a contribution to the literature of the profession which may exert upon it ultimately an influence as bene

ficial as have some even of his more practical works. Every young man should read these "Essays," for he cannot fail to derive both pleasure and profit; and men of longer professional life and larger experience will likewise find perhaps some of their best thoughts formulated into language their best judgment confirmed by the conclusions of the author. The little book will become one of the classics of professional literature.

H.

ON FUNCTIONAL DERANGEMENTS OF THE LIVER, Being the Croonian Lectures, Delivered at the Royal College of Physicians, in March, 1874. By Charles Murchison, M.D., LL.D., F.R.S., Fellow of the Royal College of Physicians, Physician and Lecturer on the Principles and Practice of Medicine, St. Thomas Hospital; Vice-President and Consulting Physician, London Fever Hospital; formerly Physician and Lecturer on Medicine, Middlesex Hospital; and on the Medical Staff of H. M.'s Bengal Army. New York: William Wood & Co. 1875.

The notice of Dr. Croon, the founder of lectures of which this little book comprises one course, constitutes a graceful introduction to a series of admirable lectures. for the preparation of which the author's experience seems to have especially qualified him. The course consists of three lectures, of which the first is occupied with the physiology of the organ, which are formulated under three heads.

1st. The formation of glycogen, which contributes to the formation of animal heat and to the nutrition of the blood and tissues; and the development of white bloodcorpuscles.

2nd. The destructive metamorphosis of albuminoid matter, and the formation of urea and other nitrogenous products which are subsequently eliminated by the kidneys, these chemical changes also contributing to the development of animal heat.

3rd. The secretion of bile, the greater part of which is reabsorbed, assisting in the assimilation of fat and peptones, and probably in those chemical changes which go on in the liver and portal circulation; while part is excre

mentitious, and in passing along the bowel stimulates peristalsis and arrests decomposition,

It will be perceived that the author very justly rejects Liebig's theory of the production of animal heat exclusively to the destructive metamorphosis of carbonaceous ingesta, in the adoption of which that great chemist seems to have so strangely overlooked one of the most obvious results of the liberation of force by the disturbance of chemical affinities.

In

In the second portion of this chapter, devoted to "functional derangements of the liver," the relations between the hepatic and renal functions, as illustrated in the development of diabetes, are clearly defined. estimating the importance of cholesterine as a pathological factor, the author differs from Dr. Austin Flint, Jr., arguing that "in cases of permanent closure of the bileduct, cholesterine is not discharged from the liver into the bowel; it does not accumulate in the biliary passages, nor, if it be present in the blood, does it necessarily give rise to cerebral symptoms." Hence, "if the non-excretion of all the elements of the bile does not give rise to cerebral symptoms, it is difficult to understand how these symptoms can result from the retention of cholesterine alone." On page 120, the author endeavors to account for the "cerebral symptoms" symptomatic of certain morbid conditions of the liver, by the presence of "leucin and tyrosin," "deleterious products of disintegrating albumen," thereby apparently placing himself in the same dilemma which he assumes to be occupied by Flint. The author proposes a new system of classification of "Functional Derangements of the Liver,” i.e. : 1. Abnormal Nutrition; 2, Abnormal Elimination; 3, Abnormal Disintegration; 4, Derangements of the Organs of Digestion; 5, Derangements of the Nervous System; 6, Derangements of the Organs of Circulation; 7, Derangements of the Organs of Respiration; 8, Derangements of the Urinary Organs; 9, Abnormal Conditions of the Skin. Which appears to be unnecessarily

extensive, the first three classes being evidently susceptible of reduction to one, from their essential correlation.

In considering the therapeutic action of mercury, the author avoids assuming a partisan attitude in reference to the cholagogue or acholagogue effect of the drug, assuming a position which, contradicting the experiments of neither side, may harmonize with both-i.e., that mercury acts by unloading the portal blood of the waste matters contained therein, and also by facilitating the disintegration of albumen.

The book deserves even a more extended notice than has been attempted here, did time and space serve for the purpose. It certainly deserves to be read by all, and if read carefully, cannot fail to be highly appreciated. Not the least of its merits is the style of its publication, which is excellent, the clear type and fine paper being very attractive to the eye of a lover of good books. H.

TRANSACTIONS OF THE TWENTY-FOURTH ANNIVERSARY MEETING OF THE ILLINOIS STATE MEDICAL SOCIETY, Held in the City of Chicago, May 19th, 20th, 21st, 1874.

The transactions comprise various addresses, appropriate to such occasions, reports upon surgery, on galvanotherapeutics, on muriatic acid in the treatment of continued fever, on malarial diseases and their treatment, on continued immersion in compound fractures, in lacerated and in pointed wounds, contributions to the report on practical medicine, report on stricture of the urethra, on necrology, on otology, on orbital tumors, and on idiocy. The report upon surgery commends highly bloodless surgery, as accomplished by the process of Esmarch, which it regards as the inauguration of a new era in practical surgery, equal in importance to those which dated from the first ligation of an artery by Ambroise Pare, and the first joint-resection. The report is equally commendatory of pneumatic aspiration, and gives the preference for the performance of this operation to the aspirator of Mathieu, Paris. The report is