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ried phenomena observed, he adduces Schmidt's demonstration of a communication between the cavity of the arachnoid and the lamina cribrosa; the latter becomes œdematous when fluid is forced from the arachnoid by increase of the cerebral pressure, and gives rise to stases and inflammation by strangulation of the terminal intra-ocular portion of the optic nerve. We have not space further to illustrate by quotations. Briefly, we regard this as one of the best works on the clinical aspects of nervous diseases.

the hemiplegia. It is alternate, on the other may recognize swelling of the optic disc, ophand, when the lesion is situated below the tic neuritis and atrophy. To explain the vadecussation. It is more reasonable to believe that a lesion situated above the nucleus, which gives rise to decussation of the facials, will produce alternate facial paralysis; that the compression of the roots of the facial will cause its appearance on the same side; and that, finally, lesion of the inferior facial nucleus will produce incomplete facial paralysis on the opposite side. Alternate facial paralysis is generally complete, and, as in peripheral facial hemiplegias, the faradic contractibility of the muscles and nerves is abolished, the galvano muscular contractibility is increased and the galvanic reaction of the nerves is diminished or lost. Lesions of the pons may also give rise to paralysis of motion and sensation in the domain of the trigeminal nerve, and to paralysis of the muscles of the eye and tongue, and of the auditory and optic nerves. Cerebral para plegias usually result from the co-existence of two distinct hemiplegias, and are caused by symmetrical foci of disease in the ganglia or in the cerebral peduncles, by circumscribed lesions in the median portion of the pons, by aneurisms at the base or by more extended processes in the pons and medulla oblongata. The association of these paraplegias with multiple paralysis of the cranial nerves is a characteristic symptom."

the ear.

In discussing "Inflammation of the Sinuses of the Dura Mater," he states that their most frequent causes are inflammations and purulent deposits within the bony parts of That inflammation of the transverse sinus may arise from mastoid disease, or from perforation of the sinus with fatal extravasation within the skull and hemor. Phlerhage through the external meatus. bitis of the superior petrous sinus may give rise to the passage of pus into the vein of the mastoid petrous canal, followed by pæhymeningitis and abscess of the brain, and suppuration of the sinus may cause the formation of deposits at the base between the arachnoid and pia mater, and be propagated thence to the jugular vein. Otitis has been observed in one quarter of the cases of cerebral ulcers. In the account given of the symptomatology of cerebral tumors the disturbances of vision are admirably stated. Amblyopia is present in about two-fifths the cases. With the ophthalmoscope we

of

Barnes' Manual for Midwives.*

The author tells us that this book was written in compliance with a request "to write a manual in which is set forth in plain language so much of the principles and practice of midwifery as it is essential for the midwife to know."

Midwives not being expected to perform any obstetric operations, all account of such have been omitted. object, Dr. Barnes has performed his task admirably. All midwives ought to know at least this much of their business, and it would not be amiss for monthly nurses to be posted to a like degree.

In accordance with his

Practitioners will promote the interests of humanity if in any degree they may prevail upon these classes to procure and study this work. But for the use of medical students, we are decidedly of the opinion that it is out of place. Playfair or Leishman contain the least knowledge consistent with the undertaking of the obstetrician's responsible position. Numerous illustrations from the larger works render the text easy of hension.

Fulton's Physiology.†

compre

Canadian students have for years been familiar with Dr. Fulton's teachings on physiology and his written text-book. The present edition being issued simultaneously in Toronto and Philadelphia, places the work

*A MANUAL of Midwifery, for Midwives and Medical Students, by Fancourt Barnes, M. D., M. R. C. P. Cloth; pages, 200; 1879. Philadelphia, H. C. Lea.

+A TEXT-BOOK of Physiology, by Dr. J. Fulton. Second edition, revised and enlarged. Illustrated Cloth; pages, 415; 1879. Lindsay & Blakiston. Price, $4.

before a larger circle of students and read- the piano in particular, cultivation creates ers. Naturally it represents the plan of artificial conditions of cerebral activity, in teaching physiology which the author has virtue of which each lobe acts singly, indefound most serviceable to his classes. Our pendently of its fellow, not only as regards first remark is that, if this satisfies Canadian psycho-motor phenomena, but also in regard students, they are easier disposed of than to mental operations of judgment and conthe students in the States. Then we do not in trolling co-ordinated motor acts. (5) In the it recognize more than the machine teaching domain of mental pathology, the aptitudes of facts. It is the play of Hamlet with Hamlet natural to the automatic activity of each left out. Clearly and accurately the facts cerebral lobe are susceptible of being reare stated, but, somehow, they impress us as vealed with remarkable energy. In the lacking that vital force characteristic of liv- insane the difference in weight between the ing words and thoughts. Then, while we mass of the cerebral lobes is much greater admit the value of a thorough training in his than it is normally. The disturbance of tology as a foundation for the study of phy-, equilibrium between each of them is much siology, it seems almost profanation to fill more strongly marked. It is the right lobe the larger part of a work on physiology with which in these cases appropriates to itself the details of histology. Altogether too the nutritive activity. The difference inlittle space is accorded to the functions of stead of being 105 grains rises sometimes to organs, and nothing is said about the evi- 375 and 450 grains without any destructive dence by which our beliefs respecting these lesion. In certain cases of insanity those functions are supported. In short, the work suffering from hallucinations with lucidity, does not adequately represent either the or in lucid hypochondriacs, the co-existence methods or spirit of modern physiology. On of lucidity and of delusion may find a rathe other hand, the book is clear, concise, excellently illustrated, and free from disturbing references and irrelevant discus

sions.

Abstracts from Exchanges. Prepared by Judson Bradley, M. D., Albert B. Lyons, M. D. and E. A. Chapoton, M. D.

Physiology.

tional explanation in the integrity of one cerebral lobe and the morbid overgrowth of certain regions of the opposite one. In a certain number of such cases, M. Luys has ascertained that the morbid process was unilateral and manifested by an unusual projection of the paracentral lobe. These facts seem to demonstrate the possibility of the co-existence of hallucination and lucidity. (6) Besides the cases thus signalized, there THE BRAIN, DUPLICATION OF ITS FUNC- are a great number of psychopathetic states, TIONS.-M. Luys (Brit. Med. Four., June 7, impulses, alienations with consciousness in 1879), from an important memoir on this which the disorder can have no other rational subject, concludes: (1) In the normal con- and truly physiological explanation than a dition of the functions of the brain, its hem- temporary want of harmony between the two ispheres are endowed with a certain auton- cerebral lobes, one of which performs its omy. (2) The left hemisphere, which is functions irregularly, whilst its fellow is in a quicker in its development, is also that which normal condition. (7) With regard to the presents the greatest mass. In general it prognosis of mental diseases, the survival of surpasses its fellow in weight by from 78 to lucidity and its persistence being well ascer108 grains. (3) While the cerebral lobes tained, there may be deduced from it confrom the point of view of certain combined clusions of a certain importance, for this psychical operations act synergically, there symptom would imply the persistent integare on the other hand a certain number of rity of one lobe only with all its dynamic circumstances in which this united action aptitudes; and reciprocally the absence of ceases to occur. Thus, in the action of artic- lucidity ascertained in a precise manner ulating sounds, and of tracing written char- would imply the simultaneous and parallel acters with the right hand, in oral language invasion of the two cerebral lobes. In fact or in written language, it is only the left it is known that the majority of persons sufhemisphere which enters into action. (4) In fering from hallucination, who at the outset. the act of playing musical instruments, and are lucid during a certain time at least, cease

to be so; and at the end of several years, by ture of such station, this fact will justify a the natural evolution of the morbid process, suspicion of abnormal change at that point. they end by being completely insusceptible (9) If there be an alteration of temperato excitation from without and more or less deprived of the comprehension of all that passes around them. In cases of this kind the lesions affect equally the two hemispheres, and dementia reveals itself with its character of absolute incurability. (8) The theory of the duplication of cerebral activity may give a rational explanation of certain morbid phenomena hitherto inexplicable.

ture at any of the lateral stations of more than two degrees above or below the average of such station, this fact will constitute strong evidence of the existence at this station of abnormal change. (10) In proportion as the alteration of temperature at any individual station is increased or decreased beyond the figures just mentioned, in exact proportion will the strength of the evidence be increased as to the existence of abnormal

THE LEGAL MARRIAGEABLE AGE.-(Lyon change at that station, until the maximum Medical, May 25, 1879.) Austria: 14 years, or minimum having been passed, the evifor both sexes; Germany: men, 18 years; dence will become almost conclusive. (11) women, 14 years; Belgium: men, 18 years; Should it so happen that such elevation of women, 15 years; Spain: men, 14 years; temperature above the average should be at women, 12 years; France: men, 18 years; any lateral station on the right, causing a women, 15 years; Greece: men, 14 years; rise at this point beyond the average temwomen, 12 years; Hungary: Catholics and perature at the corresponding station on the Orthodox, men, 14 years; women, 12 years; left, this would strengthen the evidence." Protestants, men, 18 years; women, 15 years; (12) These remarks apply with equal force Italy: men, 18 years; women, 15 years; to the average for the whole of either side, Portugal: men, 14 years; women, 12 years; as well as to the average for the whole head.

Russia: men, 18 years; women, 16 years; Roumania: men, 18 years; women, 16 years; Saxony: men, 18 years; women, 18 years; Switzerland, according to the canton: men: 14-20 years; women, 12-17 years; Turkey, at puberty.

Pharmacy.

JAMES' POWDER-ITS VARIOUS INGREDIENTS, WITH THEIR ACTION AND DOSES.— Dr. P. O'Connell (Chicago Med. Four., AuCEREBRAL THERMOMETRY.-Dr. L. C. Gray gust, 1879) summarizes our positive knowl(Four. Nervous Diseases, January, 1879,) has edge of this once celebrated nostrum as folbeen studying the brain by the thermometer lows: (1) Oxide, protoxide or teroxide of —similar in construction to Sequin's surface antimony, which is a grayish white powder, thermometer. The method was first intro- is used chiefly in preparing tartar emetic, and duced by M. Paul Broca. Dr. Gray's facts in making pulvis antimonialis, of which it lead him to the following conclusions: (1) constitutes one part in three. It is diaphoreThe average temperature of the left frontal tic and febrifuge. The dose is from one to station is 94.36°, the right being 93.71°. (2) ten grains. It is very unreliable, being someThe average temperature of the left parietal times very active and sometimes inert, owing station is 94.44°, the right being 93.59°. (3) doubtless to differences in the manner of its The average temperature of the left occip- preparation. It is said to be very mild when ital station is 92.66°, the right being 91.94°. (4) The average temperature of the left side of the head is 93.83°, the right being 92.92°. (5) The average temperature of the whole head, exclusive of the vertex, is 93.51°. (6) The average temperature of the motor region of the vertex is 91.67°. (7) The average temperature of the whole head, inclusive of the vertex, is 92.66°. (8) If there be an alteration of temperature at any of the lateral stations of more than one and a half degrees above or below the average tempera

This

well prepared and deserves perhaps to be
more used. It is obsolescent. (2) Antimo-
nious acid. Some believe it inert.
may fairly be doubted. It constitutes about
one-half to one-third of the three specimens
analyzed by Mr. Squire. To it chiefly is
due the remarkable efficacy of the drug. (3)
Calx of antimony. This is a white or grey-
ish white powder, tasteless and inodorous.
It is gently diaphoretic and laxative. The
dose is from one to ten grains. (4) Phos-
phate of lime. It is used by some on the

160 WILLIAM ST., N Y., Aug. 16, 1879.

supposition that it increases the growth of
bone. Believing that it hastens and stimu- H. D. GARRISON, M. D.,
lates the growth of callus, the French use it
largely to promote the union of fractures.
Dose, from 20 to 60 grains.

This powder is used in both acute and intermittent fevers, and in all febrile and inflammatory diseases. Its diaphoretic action is gentle and moderate. As an antiperiodic in the intermittents of children I find it quite as prompt and effective as quinine. As an antipyretic I notice a steady decrease in the temperature and pulse rate as soon as its

administration is commenced.

Wabash avenue and Jackson street, Chicago: DEAR SIR-We have your favor of the 14th inst. to hand, concerning Alstonia Constricta bark, by which we presume you mean Dita bark (Alstonia scholaris), as mentioned in the National Dispensatory.

To give you the benefit of our experience in this matter, we will state as follows: Believe that it was first known to the medical world through Mr. Gruppe, of Manilla.

We received, as far back as 1876, small shipments of twenty or twenty-five pounds from him, through the kindness of Mr. E. Merck, of Darmstadt, who also used this article in the manufacture of the alkaloid

Ditaine.

Consider ourselves the first importers of

Our small importations were sold in ten pounds (or less) lots to manufacturers, merely as experiment.

The price was $1.00 per pound.

A small quantity was delivered on account at eighty-five cents.

ALSTONIA CONSTRICTA-ITS COMMERCIAL VALUE.-The Chicago Pharmacist, September, 1879, gives the following illustration of a commercial feature of the new remedy enterprise, scarcely justifiable by any rule of same, and issued a circular in the first part action, moral or mercantile: "A Cincinnati of 1876 relating to same, which was the first firm (Merrill, Thorp & Lloyd) in advertising mention made in this country. the new remedy, alstonia constricta (scholaris) put forth this matchlessly ingenious statement: 'Some of our patrons order the powdered bark and ask if the price will not increase, like cinchonidia and other ague cures, as soon as there is a large demand, and say perhaps it will be best to lay in a considerable supply at present. In reply we can only say that we have a limited stock, obtained in an indirect way, and cannot say whether eventually the cost of importation, duty, etc., will enable the drug to be sold cheaper, or will compel an advance. We assure our friends, however, that while the present supply lasts there shall be no increase of price. There is no telling, however, when to you, we remain, the supply we now have may be exhausted, as the disease it is used in is one of the most common to our country and demands yearly an immense amount of medicine.' 999 * * "The price of the dusted powder is $1 per ounce."

Unwilling to believe that such a price would be charged to the drug trade, we caused a friend in the trade to order an ounce, which in due course of time came to hand billed at $1. To ascertain more about the cost of the drug and the difficulties to

Correspondence on the subject to London, Hamburg, Dresden, etc., resulted fruitlessly. We would not be inclined to accept any bark, except upon guarantee from a firm like E. Merck, or similar, as, being a new article and rather high priced, it offers inducements to unprincipled parties to substitute another article.

Trusting the foregoing may be of value

Yours very respectfully,

LEHN & FINK. N. B.-Our latest advices induce us to believe that a larger lot will be shipped us in the course of two or three weeks.

32 LIBERTY ST., N. Y., Aug. 18, 1879. To H. D. GARRISON, M. D., Chicago: DEAR SIR-In answer to yours of 14th inst. will say that the present price of Alstonia bark is seventy-five cents per pound. The only difficulty in supplying the present want is, that this article has been used to our be encountered in providing a full supply, only, and his stock was almost exhausted. As knowledge by one European manufacturer we addressed notes to some importers in New York, from two of whom we received the Philippine Islands and either Europe or replies which we append: the United States, and as probably the bark

there is no steam communication between

will write to our Hamburg house to get further particulars about the bark from Manilla direct, and will with pleasure submit them to you as soon as received.

Yours truly,

BRUECKNER & KOENIGSHEIM.

has to be gathered to order, the filling of the structure of the heart and blood-vessels; order will consume considerable time. We of the blood itself or of the tissues through which it courses-all entering into and modifying the pulse," we are able to adopt means to compass certain ends with far greater precision than ever before, and we can now assign digitalis its place in the list of remedies and use it without hesitancy. If, then, digitalis does act as a tonic and stimulant to the heart, as we now have abundant and conclusive proof that it does, we can readily understand how it may render useful aid to a crippled heart under certain conditions, and why it should be employed in other certain conditions with extreme caution.

An advance from five cents per ounce to $1.00 per ounce-about two thousand per cent. is a profit rather greater than druggists ought to pay in the present state of trade. Of course, we cannot state that Alstonia bark does not cost our Cincinnati friends ten or twelve dollars per pound; if so, they will, of course, be very grateful for this information. Assuming this drug to possess but a tithe of the virtues ascribed to it, its claim to rank as a boon to the medical profession and to humanity must be conceded, and therefore all obstacles to its general use should be removed as speedily as possible. The matter as it now stands, however, faintly reminds us of Cundurango, which started at $100 per pound and finally dropped to five cents per pound, and, further, after extensive trial, was practically abandoned as worthless for every purpose. Let us hope that Alstonia will command more enduring respect.

Therapeutics.

The practitioner should first define in his own mind the precise nature of the difficulty, bearing in mind that not every simple hypertrophy or valvular murmur demands therapeutic interference. "Remembering, too, the physiological action of digitalis and also the fundamental fact that nature always attempts to remedy any injury done to the valves of the heart by certain conservative and compensatory changes in its structure, we have an intelligent guide to treatment.”

"Through digitalis we can enable a heart. to overcome a moderate stenosis or obviate the chain of evils resulting from valvular insufficiency; indeed it is possible, for a time at least, to entirely relieve a leaky valve, for it is certain that dilatation may of itself render valves incompetent which are otherwise healthy."

DIGITALIS.-Walter Coles, M. D., (Richmond and Louisville Med. Journal, August, 1879,) says that the real character of digitalis Speaking generally, dilatation, or dilatahas not been well understood until recently. tion with hypertrophy, are conditions which But now the time has come when physicians are markedly benefited by digitalis. In such have no good ground for their differences of cases it not only tends to retard further inopinion as to whether digitalis in proper crease of those changes, but it indirectly doses is a cardiac stimulant and tonic. improves the nutrition of the heart itself. "Now that we have gained an insight into According to Fothergill (Antagonism of the complex mechanism of the circulation; Medicines), the effect of digitalis is to now that we know that there are various nerves supplying the heart and its tributaries capable of independent and even of opposing function; that the excitation of one set of fibres will quicken the heart, another will retard it, while still another will render it irregular in its rhythm; that one will produce fatal syncope in tetanoid systole, another will produce the same result from diastolic paralysis; that similar agencies preside over the calibre-the contraction or dilatation of even the minutest capillaries-to say nothing of the chemico-vital changes in

strengthen the systole while it lengthens the diastole; the arteries are better filled with blood, and consequently the heart itself is better nourished, while the diastolic sleep is lengthened. Between the longer rest and improved nutrition the heart is enabled to increase in power.

In hypertrophy without dilatation, or in fatty degeneration with evidences of general atheroma, we should be exceedingly cautious how we recommend digitalis.

Digitalis acts best as a diuretic in certain asthenic forms of dropsy. "It seldom suc

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