torpidity, dulness of the intellect-will be observed if looked for Pain in the head is a very common symptom, sometimes diffused, sometimes in form of hemicrania. He dwells on the importance of analysing the urine in chronic headache. Amaurosis: The condition of the eye which gives rise to this is very fully discussed. Diplopia is rare at the commencement, generally present at an advanced stage; muscæ are common; cornea and sclerotica generally sound; pupils often dilated equally or unequally; iris normal; media of eye, as a rule, transparent; irregular black patches, over which pass varicose vessels of the retina, are seen on the retina towards its periphery, being collections of choroïdal pigment; optic papilla in part or generally hyperemic, itself and the retina for some distance round it appearing turbid. In chronic cases there are seen, especially in the neighbourhood of the papilla and limbus luteus, sinall ecchymoses and yellowish patches, isolated or in groups, which are probably extravasations that have undergone fatty degeneration. The following microscopical changes are described by Charcot :-choroïd sound; retina thickened, and containing nebular patches, ecchymoses, and yellow spots; nervecells more or less the seat of fatty degeneration, molecular granules being scattered or in groups between the degenerate cells.

Passing over a few pages on the characters of the urine and on other symptoms of Bright's disease in scarlatina, which contain nothing more than is already known on the subject, we come to the chapter on Prognosis of Albuminuria in Scarlatina, wherein we read that it is important to ascertain whether the albumen first appeared in the eruptive or desquamative stage; if in the former, the chances. for the patient are much more favourable. The quantity of albumen present, its persistence, the presence or absence of fever and vomiting, and, above all, of dropsy, are weighty points for consideration. Not only is dropsy rare in France, but also rarely fatal. We look also naturally with much curiosity to his plan of treatment, and we find that it differs little from that in vogue among us. General bloodletting is condemned, cupping at the loins to be recommended. We are told to act on the skin, and to purge, but to leave the kidneys at rest. Tannic acid has completely failed in his hands.

One hundred and thirty pages are then devoted to the consideration of Bright's disease properly so called, which he defines in the most arbitrary manner as "a disease characterized by the presence necessarily of three phenomena-renal lesion, presence of albumen in the urine, dropsy more or less extensive." Without stopping to question the correctness of this definition, to which we do not think that Bright himself would have subscribed, we go on to examine briefly any points worthy of observation in his description, and such as differ from the views commonly received in this country. It may be prefaced that he recognises an acute and chronic form of Bright's disease-the former corresponding very nearly with the acute desquamative nephritis of Johnson, the latter including the varieties of disease described by Johnson in his later publication. The acute form is by no uncommon in infants and children, independent of scarlatina. Cold

no means

is an occasional but less common cause than is supposed by the English. In the symptomatology he insists on cedema in some part of the body as a necessary symptom in all cases, either acute or chronic. The acute form, as a rule, terminates favourably, but, even after a seemingly radical cure has been effected, may return; also that occasionally it may be prolonged into the chronic form. Among the complications he alludes to the condition of the stomach and intestines, to the frequency of inflammation of the mucous membrane in the great cul-de-sac of the former, and in the last part of the ileum in the latter. Small ulcers may here be met with in cases where diarrhoea has been a marked symptom, but, on careful examination, are generally found to be tubercular. The form that attacks children is sometimes very insidious, and very difficult of diagnosis, the most prominent symptom being in many cases bronchitis, which resists all treatment. In his system of treatment he differs little from the majority of English practitioners. He upholds bloodletting in the acute stage, and agrees with Johnson in recommending antimony among other remedies. Gamboge is very highly spoken of in doses of 4 or 5 grs., increased gradually to 15; it is a purgative that can be employed even in very feeble subjects. We are glad to see that he speaks in favour of diuretics, especially digitalis, but only at a particular stage in the disease-viz., after the congestion has been relieved, and before advanced disorganization of the kidney has set in. Their effect must be carefully watched, and if diuresis does not speedily follow, they are to be discontinued. Strange to say, he condemns the use of the hot-air and vapour bath, "because," he says, "carried along by routine, I have, like the rest, abused this remedy, and given as many as thirty vapour baths without obtaining any other result than that of exhausting and prostrating my patients." He does not, however, speak of his experience of the hot-air bath, which he would not, we think, condemn so sweepingly had he made proper trial of it. The water cure is, on the contrary, lauded to the skies. Of all the preparations of iron, the perchloride has answered best in his hauds; it is particularly serviceable in cases where vomiting and diarrhoea are prominent symptoms. Notes of 26 cases terminate this section, including sucklings of eleven and eighteen months, and children of various ages, from three to ten, in all of whom the dropsy was independent of scarlatina. A complete omission of post-mortem examination detracts materially from their value.

A short résumé of some very interesting pages on albuminuria in pregnancy will bring to a conclusion this first part of the book. As regards frequency of occurrence, Blot, in a series of observations made in the Clinique,' detected albuminuria once in every 5 pregnant women. The author states that the average in his own private practice was 1 in 10-the greater frequency in the former series being attributed to the comparatively feeble condition and poorer circumstances of women in a hospital. It commences, as a rule, during pregnancy, not, as is generally stated, during labour; also it ceases in most cases soon after labour is over. Primiparæ are more especially subject to it. Three

important questions must be taken into account: 1. Is albuminuria in pregnancy always attended with renal lesion? After examining the statements on the one hand of those who consider it due to a chloroanæmic condition of the blood (theory of Simpson), on the other of those who regard it as the result of renal lesion (Rayer), he concludes that, though lesion of the kidney is much more common than was supposed in connexion with albuminuria of pregnancy, there still remain a number of cases in which, even after the most careful microscopical examination, no changes of structure can be detected. In such cases pregnancy must be regarded as the cause, either by the obstruction offered to the circulation, or by causing an alteration in the blood. 2. Is eclampsia always attended with albuminuria? Not always; it may be present without any trace of albuminuria. Depaul quotes 5 such cases; Dubois, Leuret, Imbert-Goubeyre, each give 1. The author relates in full the notes of a case in which eclampsia appeared in the eighth month, and again during labour, though no trace of albuminuria or cedema could be discovered during the whole period of pregnancy. Depaul and others suppose that the albuminuria is an immediate consequence of the convulsions; this he cuts short by remarking that the observations on which the supposition is based are inexact, in that the urine was not carefully tested during pregnancy before the attack came on. On the other hand, albuminuria is often present without eclampsia; thus, according to statistics of Cazeaux, eclampsia is not met with more than once in 484 pregnant women, whereas the author has shown already that albuminuria may be found once in 10. 3. Is eclampsia in connexion with albuminuria always a manifestation of Bright's disease? Not always. Signs of Bright's disease are often to be detected, but in not more than a half of those who die of the eclampsia. He draws this conclusion relying more particularly on the result of 44 cases, given at length by Braun, of Vienna, in an elaborate paper on the subject.

The influence of eclampsia in the mother on the fœtus is very marked. Supposing that the child reaches its full term after the mother has been attacked in the course of pregnancy, it will very probably be born dead. The average of deaths is here reckoned by Braun at 40 per cent. When a woman dies of eclampsia before delivery, the child extracted is nearly always dead, or dies quickly. If eclampsia is severe enough to bring on premature labour, the fœtus is generally dead, or dies soon after birth (average of deaths, 64 per cent.). The differential diagnosis of eclampsia from Bright's disease and simple eclampsia not depending on disease of the kidney is quite possible, by paying attention particularly to the presence or absence of albuminuria for some time before the attack, and to its persistence or rapid disappearance after delivery:

"The frequent concomitance of dropsy with albuminuria in pregnancy is no positive proof of the existence of renal lesion; for the constitution of the blood of pregnant women disposes them to dropsy; and if both phenomena disappear with the birth of the child, it is certain that neither the one nor the other was connected with Bright's disease."

Treatment of the Albuminuria.-If a woman's life is in danger from the accidents to which Bright's disease may give rise in pregnancy, how far are we warranted in inducing premature labour? (a.) If we are sure that the foetus is dead, to save the mother. (b.) If the woman is so far advanced in pregnancy that the child may be fairly supposed to be capable of living, to save mother and child. (c.) When the foetus, though alive, is not capable of life out of the uterus, and when the mother is about to die, the child may perhaps be sacrificed to save the mother. This last is a very difficult question, as the decision turns on whether or not there is a fair probability of saving the life of the mother. Of eclampsia: He quotes Braun's opinions at length. Treatment may be divided into medical and obstetrical. Chloroform is most valuable, but should be administered before the paroxysm is fully developed, when rigidity of the muscles, slight twitches or spasms, and a peculiar restlessness indicate its approach. It should be continued till sleep supervenes, but should not be given when the eclampsia is fully developed. Braun is opposed to the practice of bleeding, but the author regards it as a valuable remedy in many cases. Obstetrical interference is warranted in certain conditions. If labour is already advanced when the attack commences, finish it as quickly as possible with the forceps or by turning, according to the position of the child. If there is slight dilatation of the os, rupture the membranes, and, if labour does not rapidly progress, dilate the os with the fingers. If there is no sign of approaching labour, it must be induced prematurely. Three different methods to be employed are then given; but as the opinions of Braun published some years ago are here quoted, we have thought right to give a short analysis of some papers published this year, under his direction, by Kühn, his first assistant, from observations made in the lying-in department of the hospital at Vienua.'Cf. Wiener Mediz. Wochenschrift,' No. ix., Feb., 1863.

Twenty cases of induction of premature labour or abortion have occurred there during the last three years, the various methods adopted being puncture of the membranes with the English elastic catheter or Simpson's sound, four times; intra-uterine catheterism with the elastic catheter or catgut bougie, twelve times; combination of puncture of membranes with catheterism, twice; intra-uterine injection with the apparatus of Lazarewitsch, twice. The causes which necessitated the operation were as follows: Contracted pelvis, nine times; uræmic poisoning, four times; suffocation from dyspuca in Bright's disease, twice; tetanic spasms, once; pneumonia, once; acute tuberculosis, once; chronic tuberculosis, once; chronic bronchitis, once. In 23rd week of pregnancy, 1; in 24th, 1; in 29th, 1; in 30th, 3; in 32nd, 6; in 34th, 2; in 35th, 2; in 36th, 3; in 37th, 1. In 13 cases child born alive, but 6 of 13 died shortly; in 7 child born dead. Of the women,

8 recovered perfectly, and were dismissed; 1 died after eight weeks of phthisis; 1 recovered from the operation, but was attacked with acute inflammation of knee, and transferred to a surgical ward; 10 died after labour, 4 of puerperal fever, 4 of Bright's disease, 1 acute tuberculosis, 1 hæmorrhage.

Of the different methods the preference is given to catheterism, especially in those cases where no dilatation whatever of the os is to be detected. The catheter is introduced with comparative ease through the long, soft, narrow cervix, and, after the stilette is withdrawn, pushed up on either side towards the fundus of the uterus, between it and the membranes, and left lying there. In the 12 cases where it was employed, the first pains supervened, on an average, five and a half hours, the child was born, on an average, thirty hours after its introduction. The operation was in no single instance followed by hæmorrhage; but, it must be remarked, care was taken, as far as was possible, to avoid the placenta, the position of which was calculated from a preliminary and careful estimation of the position of the fœtus. Next in favour comes puncture of the membranes with some blunt instrument. This plan is rather to be recommended in cases where the cervix is shortened, or where the os is dilated enough to admit of the introduction of the finger; thus, in cases of contracted pelvis where the head is presenting. It may be also generally employed for the production of abortion. The intra-uterine injection seems to be longer in its operation than the catheter. He advises that the opening through which the water is injected should be at the end of the catheter, and not at its side, in order that the stream of water may penetrate farther; also that the caoutchouc bladder of Lazarewitsch has the disadvantage of becoming softened by the warm water, and losing much of its elasticity and power of injecting, so that it is not to be preferred to the common enema syringe.

A very short sketch of Part II., on "Glycosuria, or Diabetes Mellitus," is all that space will permit. This is the less to be regretted, in that a full review of this subject, in the October number of this Review for 1862, contains a much clearer and more complete exposition of the physiology and pathology of sugar than could possibly be given in an analysis of these eighty pages, however full it might be.

There is a remarkable analogy, he observes, between albuminuria and glycosuria. Thus, the presence of sugar, as of albumen, in the urine may be either transitory or persistent: in the one case, a symptom per se of little or no import, occurring in connexion with certain diseases, as epilepsy and hysteria, blows on the head, a sudden and severe hindrance to respiration, certain diseases of the liver, stomach, and lymphatic glands; myelitis: in the other, a symptom in like manner, but directly indicative of some serious and fatal constitutional disorder, the point de départ of which, though still sub judicê, will, it is to be hoped, as certainly be determined by future investigators, as was the kidney by our own Bright, in the history of albuminuria. For the detection of sugar in the urine, Barreswill's solution is highly spoken of, but it must always be fresh. Names mentioned in connexion with theories to account for diabetes are those of Bouchardat— formation of an excess of sugar in digestion and introduction into the blood; Bernard; Mialhe-deficient alkalinity of the blood, which renders impossible the destruction of glucose in the economy; Raynosoan impairment in the functions of respiration, whence follows an