early he would operate, believing, as he does, the doctrines of cancer as laid down by Mr. Moore, Dr. Hughes Bennett, and others. Moreover, he appears to approve of the removal of the testicle when arrested in the groin, quoting in favour of the practice the fact that such testicles are useless, without ability to secrete true spermatic fluid, and that, besides this, they are more prone to cancer than the normal organ, and also will give rise to more suffering when attacked by inflammation of any sort.

Dr. Reginald E. Thompson describes the results of Thermometrical Observations in Typhoid Fever, carried out by himself, and which proved in general confirmatory of those made and recorded by Wunderlich. Dr. Thompson found that the thermometer afforded no reliable criterion for diagnosis between typhoid fever and certain other diseases, though it sufficed to distinguish it from acute granular kidney, meningitis, and peritonitis, as likewise to appreciate intestinal lesions before they were recognised by the ordinary symptoms. Moreover, the thermograph of typhoïd supplies an additional distinction between this fever and typhus. A table of observations in a case of typhoid fever is appended.

Aphasia and Agraphia constitute the subject of one of the longest essays in the volume. It is a contribution by Dr. William Ogle, presenting a summary of the present state of knowledge of those maladies, accompanied by critical remarks and brief records of cases that have occurred in St. George's Hospital. Dr. Ogle upholds the hypothesis of MM. Dax and Broca, as to the localisation of the faculty of ar ticulate speech in the inferior or third frontal convolution of the left hemisphere, and attempts to overturn the arguments against it advanced by Trousseau and others. To meet the objection that in a double organ so symmetrical as the brain it is hard to conceive a difference of function between its two sides, he makes the most of the absence of exact symmetry in the arrangement of the convolutions; but being dissatisfied, apparently, with the cogency of the argument so derivable, he resorts to the remarkable suggestion of Dr. Moxon, that we may, and, if Broca be right, universally do, educate the left hemisphere as the organ of language in a much higher degree, or well nigh to the exclusion of the right half of the cerebrum. And in support of this notion he appeals to anatomy, which, as he conceives, shows that the left hemisphere receives by the left carotid a more direct, and therefore freer supply of blood than does the right, by reason of the mode of origin of that carotid from the aortic arch. He farther urges that the left hemisphere

is more fully developed at an earlier period of existence than the right. We must, however, confess that these anatomical arguments do not at all satisfy our mind, even were they valid, which we doubt; and we are likewise unwilling to believe the right hemispherical frontal convolutions to be in vain and of no purpose in the cerebral economy, an inference Dr. Moxon's hypothesis would involve. If they remain normally so uneducated or so unused, how is it they acquire and retain equal dimensions with those on the left side? We have, however, no space at present to take up with this discussion. In further notice of this essay, we may state that Dr. W. Ogle follows Trousseau in recognising two forms of Aphasia, termed respectively, Amnemonic and Atactic; the former implying that condition in which appropriate words fail the patient, owing to a defect of memory, the latter failure in the power of co-ordination of the muscles necessary to articulation. The two disordered conditions are frequently associated together.

Agraphia is the term invented to designate inability to express ideas in written language, and this faulty condition is distinguished as of two kinds, just as in the case of aphasia, viz. the amnemonic and the atactic. In the former the patient misuses words, or writes a confused series of letters, having apparently no connection with the words intended; in the latter, the power of writing even separate letters is lost, and only meaningless strokes made with the pen.

Loose cartilages in the knee-joint, especially such as result from accident, are briefly considered by Mr. Brodhurst, who draws the conclusion that, as a rule, they are detached portions of semilunar cartilage, set free within the cavity of the joint. A case is related where the loose cartilage was removed as early as six weeks after the accident producing it.

Mr. Edgcombe Venning opens the question of diagnosis between infecting and non-infecting chancres, and, after a brief discussion, illustrated by cases, expresses his belief that the infecting form is always attended with the amygdaloïd enlargement of the glands of the groin, an opinion not many will endorse.

The limits allotted to this review constitute a bar to even the shortest adequate analysis of the contents and conclusions of many of the valuable contributions collected in this volume of reports. We must consequently pass over some of the remaining papers, very unwillingly indeed, with little more notice than that of their titles.

The serious and rare form of morbid growths known as naso

pharyngeal polypi are well described, and their treatment carefully discussed by Mr. Thomas P. Pick. These tumours do not, as generally supposed, invariably grow from the base of the skull, for M. Robert describes one that appeared to be connected with the fibrous tissue in front of the cervical vertebræ. They increase rapidly, and individuals afflicted with them live but comparatively a brief period. To diagnose their nature and attachments is not generally so easy as might be imagined. Various plans of treatment have been suggested and adopted: these Mr. Pick has carefully noted, citing published cases, and in summing up his inquiries remarks:

"That the methods by the palate and by the ligature are inadmissible on account of the fact that the root of the disease cannot be reached. Of the method by the galvanic current we do not possess sufficient experience to speak with any degree of certainty. There remains, then, only the methods by the nose, and by the removal of the superior maxilla. The former of these methods is applicable to and is to be preferred in polypi of small size; whilst the latter must be employed in cases where the tumour is large, and especially where it has prolonged itself in the manner mentioned above."

The liability of such tumours to return after their excision is as yet a problem not satisfactorily solved.

Croup and Diphtheria, and their treatment, is the subject of a communication by Mr. J. W. Haward. This writer advocates tracheotomy early in diphtheria, to avoid the exhausting effects of the dyspnoea, otherwise urgent, and he " 'goes so far as to think that no child should be allowed to die of suffocation, however bad and hopeless the case; for we have at present no means of judging how far the exudation has extended, and I do not think the existence of bronchitis should exclude the operation." He adds the caution, that the operation should not be hastily performed. The differential diagnosis is well

examined.

The Signification of Skin Affections in the Classification of Disease is a philosophic disquisition of much merit, by Dr. C. Allbutt, which must be read through to be appreciated. Mr. Nourse narrates more or less briefly some seventeen" Cases of fever" of various sorts, with the view of elucidating their origin. A much larger series of cases, however, is needed to give weight to the conclusions he would draw. At the same time it may be remarked, Mr. Nourse's inferences agree in the main with those generally received by the profession.

On the Forms of Pneumonia. This is a contribution of con

siderable length, wherein the author, Dr. Sturges, examines critically the various morbid conditions comprehended under the general appellation pneumonia. In carrying out this examination Dr. Sturges avails himself of the cases placed on record at St. George's Hospital during the last twenty years, excluding such as were connected with tuberculosis, or with secondary deposit. The cases collected, and which are also most carefully tabulated, exhibited, for the most part, that stage which has been called red hepatisation; and whether they be held to prove the author's deductions or not, they constitute in themselves a monument of his industry, and a repertory of observations valuable to all future inquirers into the pathology of pneumonia.

În the course of the labour of tabulating the cases, Dr. Sturges observes that he

"Soon found that all the fatal instances of so-called pneumonia occurring in a series of years fell naturally, in view of their clinical histories, into four classes. The first and largest class would comprise patients who died of tedious and exhausting diseases of whatever kind, such as the constant drain of an abscess.... or generally where lingering was unusually prolonged, and emaciation extreme. Lung consolidation, indeed, is a familiar appearance in connection with this form of decay......A second class would consist of the subjects of a specific fever, or of some definite affection of a secreting organ, and conspicuously of uræmic poisoning and the poison of typhus......In a third class hepatisation would seem due almost entirely to mechanical causes, and quite independent of any inflammatory affection whatever...... Fourthly, hepatisation occurs, there is reason to suppose, as the result of idiopathic inflammation of the lung. It is then invariably connected with pleurisy, and often with pericarditis. It runs a rapid and tolerably uniform course, and would seem to be but rarely fatal."

Having thus indicated four varieties of morbid action, the author proceeds to examine each in turn from a pathological stand-point; and he points it out as a curious circumstance, that wherever recent pericarditis is associated with marked pneumonia, it is always the right lung which suffers either mainly or solely.

The general conclusion is, that the term pneumonia, if retained, can apply only to a certain combination of physical signs, which, in themselves, are diagnostic of no one disease or morbid entity. This being so, the "laudable attempt" made of late years by Dr. Hughes Bennett to test the comparative efficacy of various modes of treatment in certain definitive diseases by means of statistics must be, so far at least as concerns

the selection of pneumonia for that purpose, both inconclusive and abortive.

For

"Simple pneumonia is rarely a fatal disease under any mode of treatment; and as a secondary disease the associations of pneumonia are so many and various, that it seems almost hopeless to attempt a classification sufficiently precise to bring cases into fair comparison. In a word, if the term pneumonia be used to express all the cases of consolidation which I have been noticing, or the majority of them, no disease can so little be treated in this way or that because of its name. If, on the other hand, the word is to be restricted to pure uncomplicated cases of inflammation of the lungs, it is clear that our knowledge at present does not enable us always during life to discriminate such cases. The argument of treatment derivable from tables must concern itself with simpler diseases than this."

Dr. John W. Ogle, one of the editors of the volume, recounts a case of death from hemorrhage into the pericardium, as a result of rupture of one of three true and circumscribed aneurysms of the coronary artery of the heart, and follows with observations on aneurysm or aneurysmal dilatation as a result of embolism or thrombosis. A woodcut shows the position of the aneurysms and of the rupture. The writer carefully examines the relation discoverable between the lesions found after death and the symptoms presented by the patient during life. Cases of aneurysm of the cardiac coronary are very rare, and Dr. Ogle has done good service in culling examples from all available records in illustration of the history and pathology of the lesion, and also in reviewing them in connection with the instance that fell under his own observation. The same writer has likewise contributed a most instructive and copious collection of "Instances of some of the rarer varieties of morbid growths, swellings, &c., connected with the organs contained within the abdominal cavity," and purposes, in a future number, to add to this present collection. He informs the reader that he has gathered the instances now published from the hospital records, and from practice among the out- and in-patients, as illustrating difficult points of diagnosis, or as presenting features of interest as regards morbid anatomy determined by postmortem research. The cases related, their features during life, and the appearances noted after death, may be divided into three groups: "1. Affections of the peritoneum, stomach, intestines, liver, pancreas, and lymphatic glands. 2. Affections of the uterus and urinary bladder. 3. Affections of the bones, arteries, &c."

This catalogue of cases offers, we think, a valuable supplement to Dr. Bright's excellent clinical essay on abdominal tumours.