antitoxin and disinfection are fully discussed. The opinion is expressed that formaldehyde gas will doubtless revolutionize the system of disinfection as now practised. Formalin (forty-per-cent. solution of formaldehyde) is recommended for the disinfection of bank bills which may possibly be infected with smallpox.

NINTH ANNUAL REPORT OF THE METHODIST EPISCOPAL HOSPITAL, 1896. Pp. 277.

No hospital report comes to us which is more worthy of commendation than this, nor is there one which shows a greater amount of medical and surgical work done with the means at the disposal of the staff. Twelve hundred and twenty-four patients were treated during the year, of which 684 were cured, 238 improved, 73 unimproved, and 153 died. The summarized reports contain about every medical and surgical disease and injury to be found in a medical dictionary. The detailed report of cases treated is a model of conciseness and precision of medical history recording.

The report of the pathologist shows 317 morbid specimens examined.

In the dispensary, or out-patient department, 7000 visits were made; it is not stated how many individuals this represented.

It is interesting to note that the receipts of the dispensary did not pay the expenses. Thus, there were received from the city $1500, from patients $532.03; this we presume was for medicines, etc. The expenditures were : Drugs and medicines, $364.18; surgical dressings, $191.62; all other supplies, $136.98; salary of pharmacist and nurse, $500; rent and janitor, $1000. Had there not been a balance of $160.75 carried over from the previous year there would have been a deficit. We commend these figures to the consideration of those who think that the conduct of dispensaries is a money-making business.

A TREATISE ON APPENDICITIS. By John B. Deaver, M.D., Surgeon to the German Hospital, Philadelphia. Containing 32 fullpage plates, and other illustrations. Philadelphia: P. Blakiston, Sons & Co., 1896. Pp. 168.

Dr. Deaver has endeavored in this monograph to emphasize the etiology, symptomatology, and special technic in the operative treatment of a disease, which, at the present day is more often mentioned by both the profession and laity than all other diseases combined. His observations are the result of an experience in the treatment of over five hundred cases.

Physicians are often asked how it is that appendicitis, now so frequent, was never heard of until recently, and the query is often put whether it may not be due to bicycling. The witty ex-president of the County Medical Society, Dr. Walter B. Chase, suggests that these questioners might be left to draw their own inferences, after being told the story of the manner in which the country preacher silenced his skeptical congregation when he told them that the children of Israel crossed the Red Sea on the ice, and they inquired how that could be when their geographies said the Red Sea was so near the equator. His answer was that the crossing of the Red Sea happened when there was no geography and no equator.

In the portion of the volume before us in which the "History of Appendicitis" is discussed will be found the true answer to the question. During the

first half of the present century almost all inflammatory conditions localized in the right iliac fossa were ascribed to diseases of the cecum, although cases had been reported in which perforation of the appendix had been found. It was not until 1803, when Laennec gave a complete description of the peritoneum, that this structure was at all comprehended, either in its anatomy or pathology. And so if we follow the matter up we shall find cases of typhlitis, perityphlitis, and paratyphlitis without number, but the appendix was not recognized as being the true structure involved. Husson and Darrel in 1827, Villermey in 1824, Melier in 1827, Burne in 1837, Albers in 1838, Grisolle and Voltz about 1840, Hancock in 1848, Willard Parker in 1867, and F. F. Noyes in 1883, and others, all made important contributions to the elucidation of this most obscure subject, but “the epoch-making memoir" is the paper of Regi. nald Fitz of Boston, published in 1886, followed in 1888 by another. He advanced the theory that the diseases described as typhlitis, perityphlitis, paratyphlitis, appendicular peritonitis, and perityphlitic abscess, are all varieties of appendicitis.

We have not the space to follow further this interesting and instructive book, which will, we are sure, find a prominent place in medical literature. The anatomy, etiology, pathology. symptomatology, diagnosis, prognosis, treatment, complications and sequelæ and after-treatment are fully and thoroughly discussed. The illustrations are admirable, and truer to life than many of the colored illustrations usually seen.

PRINCIPLES OR GUIDES FOR A BETTER SELECTION OR CLASSIFICATION OF CONSUMPTIVES AMENABLE TO HIGH ALTITUDE TREATMENT, AND TO THE SELECTION OF PATIENTS WHO MAY BE MORE SUCCESSFULLY TREATED IN THE ENVIRONMENT TO WHICH THEY WERE ACCUSTOMED PREVIOUS TO THEIR ILLNESS. By A. Edgar Tussey, M. D., Adjunct Professor of Diseases of the Chest in the Philadelphia Polyclinic and School for Graduates in Medicine, etc. Philadelphia: P. Blakiston, Sons & Co., 1896. Pp. 144. Price, $1.50. The tendency in the medical profession to send all tubercular patients to Colorado or other high altitudes receives a most decided and most deserved check in this little book of Dr. Tussey. He believes that many cases are sent away from home to die that would have done much better at home. He thinks that only those physicians who have made a study of the matter should decide so vital a question as the sending away or keeping at home tubercular patients, and that an elevation of 1000 feet will often do as much for one as 2000 feet will for another. We commend his views to all who are concerned in the treatment of these cases, and what physician in active practice is not? HARE'S SYSTEM OF PRACTICAL THERAPEUTICS. Messrs. Lea Brothers & Co. announce a new volume of this system.

To ensure complete freshness of material, Dr. Hare has assigned the various subjects to a new corps of authors who have dealt with them in their en tirety, devoting, however, most attention to the later advances. This arrangement renders the new volume, Volume IV., quite as serviceable to those who have not, as to those who have the preceding three.

It will contain 1100 pages, with illustrations.

BORDERLAND STUDIES.

Miscellaneous Addresses and Essays Pertaining to Medicine and the Medical Profession, and their Relations to General Science and Thought. By George M. Gould, A. M., M.D. Formerly Editor of The Medical News. Philadelphia P. Blakiston, Sons & Co., 1896. :

Price $2.00.

Pp. 380.

This volume contains essays which have already been published, but are ́ now out of print, together with others hitherto unpublished, twenty-four in all, and treating of subjects as diverse as " Vivisection and "Immortality." There are few men in the medical profession so many-sided as Dr. Gould, and whether his pen is taken up to write a medical dictionary, a book on "The Meaning and Method of Life," or an essay on "Dreams, Sleep, and Consciousness," the reader may be sure that the result will be something worth reading and preserving. The great variety of Dr. Gould's knowledge and attainments can In no way be better shown than by quoting the titles of the essays contained in "Borderland Studies." The first is on "Vivisection," then follow "Concerning Medical Language," "The Role of the Maternal Instinct in Organic Evolution,' 'Life and Its Physical Basis,' Is Medicine a Science ?" "The Duty of the Community to Medical Science,” “Charity Organization and Medicine," "Hospitalism," "The Etiology, Diagnosis, and Treatment of the Prevalent Epidemic of Quackery," "The Untrustworthiness of the Lay-Press in Medical Matters," etc., etc.

We have been especially interested in the essay, entitled "Concerning Medical Language," and have derived much profit from its study. It is very difficult, however, always to live up to a standard, even when the standard is of one's own erection. As an instance of this we quote the following: "Abolish all diereses and accents. They cannot teach pronunciation, and they are use. less luggage. * * * When a foreign word is Anglicised let us do it completely. Leave to the poets the acute, the grave, and the circumflex accents that are foreign to the spirit of our own tongue." And yet, in the essay on "Dreams, Sleep, and Consciousness," we are told that "we do things outrageously mal-à-propos."

CORRESPONDENCE.

PROFESSIONAL CONFIDENCES.

BROOKLYN, March 17, 1897.

TO THE EDITORS OF THE BROOKLYN MEDICAL JOUrnal :

SIRS: At the last meeting of the Kings County Society the subject of "Professional Confidences, With Especial Reference to the Legal Duties of Physicians in Cases of Criminal Abortion," was ably presented in a paper by Dr. Raymond, and discussed by several distinguished gentlemen of both the legal and medical professions, the conclusions formulated being briefly as follows: That the physician is bound to keep inviolate his patient's secret (in the case of criminal abortion) in the event of her recovery; that in the event of a fatal issue he is expected to inform the authorities, indeed, is compelled to do so (Hon. Willard Bartlett). Again, in case of a fatal outlook, he should perhaps endeavor to induce his patient to make an ante-mortem statement to the proper authorities, without violating his professional confidences, incriminating, if possible, the guilty party or parties. In brief, he must further the ends of justice in some way, and at the same time keep inviolate his Hippocratic oath (Hon. Foster L. Backus).

Dr. Skene contended that under no circumstances should the physician betray confidences of a criminal nature communicated to him by a patient, information necessarily imparted in order that he might treat the case rationally. In case of death, the certificate, of course, was to be withheld.

These are all interesting points, but there are other phases of the question with which the luckless practitioner is apt to collide. For instance, the honorable district attorney raised the question as to post-mortems by the private physician himself in cases of doubt as to the true nature of a case, whether criminal or innocent, certainly a somewhat original interrogation. It is in this connection that I wish to relate a few facts bearing on this particular subject, since I was so unfortunate, a few months ago, as to beard the lion of the law in this very way.

It came about in this way. A well-known physician of this city was called on the morning of July 23d last to visit a young unmarried woman. He found her suffering from pelvic perito

nitis and cellulitis: She told him that she had been sick for three days, and had been under treatment by another physician, who had either resigned from the case or been discharged. The doctor found his patient suffering from severe abdominal pain, associated with great prostration. The physical signs were those of severe pelvic inflammation. She volunteered the statement that she had missed one menstrual period and had taken five grains of quinin and a hot foot-bath (hardly potential factors in an abortion), with the idea of inducing menstruation, endeavoring to persuade the doctor that her condition had been brought about in an innocent attempt to bring on the menstrual flow. She strenuously denied everything tending to criminality (which the doctor sought judiciously to prove). She had bled profusely. The doctor prescribed quarter-grain doses of opium with two-anda-half-grain doses of quinia every three hours. Stimulants, milk diet, and liquid peptonoids were also ordered.

This treatment was continued until July 27th, when a powder of pulv. Doveri and bismuth was substituted. After two days it was found necessary to resume the first opiate. On the evening of July 28th two morphia tablets (aa gr. ) were prescribed, one to be given at once, the other to be repeated in two hours, if necessary. She died on the morning of July 29th, at about 5:30 o'clock.

The perplexing circumstances in the above case will be readily seen. The misleading statements of the patient, her denials of unchastity and of criminal operation, the good character given her by her family (“had never been seen with a man”), the lack of direct physical evidence, all combined to invest the case with uncertainty. Suspicious, however, it certainly was. Rare indeed must be the conditions present in this woman, as shown by the post-mortem, from other than criminal causes.

Yet the element of uncertainty existed. The doctor hesitated. Would he notify the authorities and bring odium, perhaps totally unwarranted, on a family, and at the same time violate his Hippocratic oath? or would he render a certificate of death from natural causes? The latter he could not conscientiously do, since the case was a suspicious one. In his dilemma he sought the advice of an eminent colleague, by whom he was advised (probably with perfect propriety) to satisfy himself of the pathological conditions, the possibility of gonorrheal infection being suggested.

I performed an autopsy, by request, on the body of the de