carefully made, and a very ample and clear account of the pathological condition of each part is given.

The Action of the Venom on the Tissues and Fluids," forms the subject of the seventh chapter. The power of the stomach to absorb the venom of serpents is the most important question here brought forward. The experiments of Harlem, Mangili, Russell, Davy, and others, are all referred to and their evidence taken as conclusively establishing that the unbroken mucous surface of the stomach is incapable of absorbing this poison, "or of admitting it into the system in any form possessing noxious properties."

The effects of the venom on the pulmonary tissue, on muscle, on the heart, on the capillary system, upon the intestinal movements, upon ciliary movements, upon the nervous system, the sensory and motor nerves, and the nerve-centres themselves, upon the calorifacient functions, and upon the blood, are all duly considered and discussed through the medium of well devised and adroitly carried out experiments.

The eighth and last chapter refers to "Crotalus Poisoning in Man." Dr. Mitchell begins this chapter in a somewhat apologetic strain; and as his own words will best convey an idea of the difficulties under which he has laboured, when endeavouring to make this part of the work as complete and accurate as he wished, we proceed to quote them.

"The cases of rattlesnake poisoning in man have been separated from the rest of this paper, owing to the difficulty of grouping the phenomena of human poisoning with those observed in animals. This difficulty arose from the imperfect reports of such cases as have been recorded, and from the fact that, in man, the symptoms were possibly modified, in some instances, by the remedies used, and were thus no longer comparable with such as had been seen to exist in animals submitted to no modifying treatment. Unfortunately, although I have collected at least fifty cases of crotalus bite, the most of these scarcely deserve the name of medical reports; and among the whole number, I have been able to select but sixteen, which were sufficiently rich in details to be of the slightest value. The numerous gaps in the accompanying table

* *

** *

show but too well the want of full medical statements of the order and character of the symptoms, even in these select cases; and it is humiliating to observe that, of the four post-mortem examinations of the lesions in this mode of poisoning, but two were made in this country.

"If, then, in the table of symptoms in man, and in the following remarks upon them, such a lack of detail is met with as would disgrace the most ordinary report of an interesting case,' the blame must rest where it belongs, with the physicians of our own

country, who have failed thus much in their duty as medical observers."

After these remarks, the writer proceeds to say that whatever may be the amount of difference in the virulence of the poison secreted by the different kinds of venomous snakes, the mode of affecting the system varies but little whether the injury be inflicted by the viper, the copperhead, the rattlesnake, or the dreaded, but not more deadly, cobra. He then gives the tables referred to in the above quotation, and subsequently dwells upon the following points: the sex of those injured; the situation of the wound; the local symptoms; amount of hæmorrhage from the wounds; local results; the constitutional symptoms; and the post-mortem examinations he has previously expressed so much dissatisfaction with.

The remaining part of the chapter is occupied with some brief allusions to the various antidotes which have from time to time enjoyed a short-lived reputation. Professor Mitchell

divides these in the following manner :

"1st. Those which remove the poison and the poisoned partexcision and amputation.

"2nd. Those which partially remove the venom, and more or less detain it in the wounded part:--ligature; scarifications; suctions;

caustics.

"3rd. Those agents which, being injected into the wound, or wounded part, are supposed to destroy the venom, or to render it innocuous, as injections of iodine.

"4th. Local applications of various substances, as alcohol, ammonia, indigo, olive oil, &c."

Of all the above the author seems to think disparagingly, saving and except amputation, excision, and caustics, when not too long delayed; he approves of the administration of stimulants.

At the end of the work there is an appendix (A), which gives "An Enumeration of the Genera and Species of Rattlesnake, with synonymy and references," by E. D. Cope.

There is also another appendix (B), giving a most ample bibliography.

The second work at the head of this article is a reprint from the North American Medico-Chirurgical Review' for March, 1861, and may be considered as a supplement to the first; it displays the same painstaking and accurate experimental examination of all the various proposed remedies for rattlesnake bite that marks the former work, and is, moreover, suggestive on many topics not mentioned in the larger book. The third con

tribution of Professor Mitchell is also a reprint, in this instance from the New York Medical Journal,' for January, 1868. The following extracted paragraphs may serve to show, perhaps, the motive which gave origin to this publication, and they may also indicate to those who have read the two first published communications, the desirability of not neglecting a perusal of this one, containing as it does the most important of this distinguished physiologist's researches and discoveries in connection with the ultimate mode in which the rattlesnake venom affects the economy of animals."

"In the year 1860 I published, through the Smithsonian Institution, a paper of 117 quarto pages, upon the 'Anatomy, Physiology, and Toxicology, of the venomous organs of the Rattlesnake." From the days of Fontana, 1781, no researches of any moment had added to our knowledge of the poison of serpents; and I had, therefore, the pleasure of contributing a large amount of completely new information to the modern history of animal poisons.

"Since the date of my Smithsonian Essay,' and of a paper on the treatment of snake bites which I published in the North Amer. Med.-Chir. Rev.,' March, 1861, I have suspected that in at least one point I was partly, and in another, altogether wrong, so that it became an imperative duty to correct my former experiments by a second, and more careful examination of the dubious conclusions which I had committed to print.

"As usually happens with those who question nature by the fertile method of experiment, I was gradually led aside into by-paths, which proved to be of the utmost interest, so that, besides the questions with which I started, I have found myself able to answer many others of equal, and some of far greater interest."

The subjects dealt with are classed as follows:

1. What is the dose fatal to pigeons?

2. Why is venom harmless when ingested by animals? 3. What surfaces have the power to absorb venom?

4. How does it act directly on the tissues?

5. Does it alter the blood, and how?

6. Is the venom poisonous to the serpent itself?

7. Is it capable of being physiologically neutralized by any of the agents introduced into practice since 1861, such as the sulphites and carbolic acid?

This notice has already been extended beyond the usual limit; we cannot, therefore, venture into a seriatim account of the conclusions arrived at upon the various questions raised above, but would direct especial attention to the experiments carried out to determine the manner in which the poison of the "Crotalus" affects the various tissues as being of the first importance, and of the highest interest.

Dr. S. Weir Mitchell's fame as an original investigator and physiologist, already places him in the foremost rank; and we are confident that these contributions to the literature of a confessedly very difficult subject, cannot fail to add another leaf to his well earned laurels.

REVIEW III.

St. Bartholomew's Hospital Reports. Vol. III. pp. 486. THIS Volume of St. Bartholomew's Hospital Reports' contains twenty-five papers, and is prefaced by a memoir of the late Dr. Jeaffreson, physician to the hospital, who died at the end of the year 1866. The memoir does no more than justice to the memory of a most accomplished physician and estimable man, who, although he never lectured on medicine, and, unfortunately for his contemporaries and for posterity, never placed upon record the results of his extensive experience, was nevertheless held in the highest esteem by the students of the hospital, was consulted by a large circle of patients, and was beloved by a host of friends. It is satisfactory to learn that, although Dr. Jeaffreson had barely passed the middle period of life, his practice had been so successful that he amassed a very considerable fortune, and was about to retire, at least partially, from his professional pursuits, when death put an end to his distinguished career. Although his prospects, on starting in life, were not brilliant, he never had struggled with adversity: on the contrary, he was favoured in his youth by the friendship and active assistance of many persons of influence, and the advantages thus gained he turned to the very best account, and fully justified the estimate which had been formed of his character by those who were best qualified to form a judgment.

I. Some Statistics of Pyæmia. By WILLIAM S. SAVORY, F.R.S.-In this paper Mr. Savory has collected the particulars of what seem to be the main features of 133 cases of pyæmia, ninety-five of them having been taken from the pages of the Medical Journals and the remaining thirty-eight having occurred in the wards of the hospital during three years. All the cases mentioned occurred in British practice, and no doubtful or questionable cases were included in the tables. Mr. Savory thinks that in some important facts the records of

pyæmia are deficient, as, for instance, in omitting to mention whether there is any evidence of infection from without, and whether there has been proximity to other cases. Although pyæmia is often spoken of as arising from contagion, there is no evidence to show that it does so in the same manner as scarlatina or smallpox. But pyæmia commonly supervenes on foul wounds, and the emanations from these wounds may impregnate the atmosphere, and may be carried to adjacent healthy wounds in other persons, and in them create morbid action. It is generally thought that this disease is specially prevalent in hospitals, but this opinion may be partly due to the facts that patients are often admitted into hospitals who are already the victims of the disease, that cases in hospitals are more carefully recorded than those which occur in the houses of the poor, and that the great majority of persons who are the subjects of injuries or operations likely to be followed by pyæmia are admitted into hospitals. Still there can be no doubt that certain conditions sometimes prevailing in the best hospitals may predispose to pyæmia, because it is almost impracticable to avoid having an undue number of open wounds or sores in a ward, and then the atmosphere is likely to become tainted, in spite of the utmost care. The tables yield little support to the view that phlebitis or even thrombosis is a necessary antecedent of pyæmia. The earliest symptom of this disease, according to nearly all the tables, was rigor or shivering, and this symptom is the more diagnostic when, as is almost invariably the case in pyæmia, it is immediately or very rapidly followed by profuse sweating. The rigors appear to Mr. Savory to stamp the relationship of pyæmia to the specific fevers, and they may be regarded as indicating the operation of a poison in the blood in both cases.

II. Practical Observations on the Nature and Medical Treatment of Obstruction of the Bowels and upon Constipation. By THOMAS HEAD, M.D.-Dr. Head draws a distinction between obstruction of the bowels, or an entire interruption of their ordinary functions, and constipation, which is a less serious affection. The former most commonly arises from intussusception and from the lodgment of particles of undigested food in or near the ileo-cæcal valve, and more rarely from hernia and from malignant disease of the bowels; the latter has its seat almost exclusively in the large intestine. In one of the cases related, which was that of a child five months old, there was obstinate obstruction of the bowels, and the treatment adopted by Dr. Head was to inject warm oil and quicksilver into the bowels, and then to hold the child up by the legs so as to allow