manifestly be much more efficacious than its internal administration, notwithstanding its vaunted power of dissolving cholesterine.

In these days when cures for cholera abound, our readers will not be surprised to learn that chloroform possesses anti-choleraic virtues unsuspected by many. Not only has it been given with success internally, combined with opium and other drugs, but also by inhalation, and we are directed to keep the patient under its influence until all symptoms indicating danger have passed away.

Fifteen cases of intermittent fever were cured by Bonafont by inhalation of ether or chloroform. The inhalation was employed six hours before the expected attack; if the latter was once escaped completely, further treatment was unnecessary; the cures were all permanent. The patients preferred this mode of treatment to that by sulphate of quinine. In Spain, Poblacion and others have found the internal administration of chloroform useful in intermittents.

In cases of strychnine poisoning, chloroform inhalation has proved itself of great service. The following example is interesting:-A man, 40 years of age, whose habits were somewhat irregular, drank in mistake for morphia, the contents of a bottle which held a solution of strychnia. In twenty minutes the following symptoms manifested themselves:-Rigidity of all the muscles, contraction of the muscles of the back, and of the upper and lower extremities, retraction of the head, difficulty of speech, oppression about the chest, profuse perspiration. The means usually resorted to were fruitlessly employed. It seemed as if the patient would succumb to the severity of the spasms, and death appeared inevitable unless speedy assistance were afforded. Dr. Mannson, at this juncture, administered chloroform. Two grammes were poured on a pocket-handkerchief, which was held so that the patient could conveniently inhale the vapour. He was then in the sitting position supported by many assistants, but soon desired to be laid in bed. The inhalation was continued off and on for many hours, the patient himself holding the handkerchief to his nose in order, as he said, to cut short the cramps. These gradually disappeared, and after two days the patient was perfectly well and able to resume his usual occupation.

In a physiological digression the author explains the presence of sugar in the urine, after the inhalation of ether or chloroform, by the impairment of respiration, which interferes with the supposed combustion, in the lungs, of the hepatic sugar. That the diabetes is not due to a reflex influence exerted through the pneumogastric nerves on the medulla oblongata, is shown by dividing the vagi in

the neck of a rabbit, previous to the commencement of the inhalation, after which sugar appears in the urine just as if no operation had been performed. The diminution of animal heat, which Duméril and Demarquay have shown to be consequent on the inhalation of ether or chloroform, is independent of respiratory disturbances, and is supposed by the author to be caused by a specific action exerted by the anesthetic on the nervous system.

This chapter terminates by a consideration of the combined influence on the body of chloroform and morphia. A combination of these for internal administration may be prepared as follows (Bernatzik):—One part, by weight, of morphia is dissolved in two parts of rectified wine vinegar and twenty parts of rectified spirit of wine, and the solution, when cold, is mixed with eighty parts of chloroform-one drop contains the so part of a grain of morphia. Dose for a child, two to fifteen drops; for an adult, thirty to forty drops. It is said to give relief in most painful affections much more quickly and certainly than morphia alone, and to leave none of the unpleasant after effects of opium. The subcutaneous injection of morphia, during chloroform narcosis, is strongly advocated in all those cases where it is desirable to maintain the state of unconsciousness for a lengthened period.

In the following chapter, some of the more important surgical applications of chloroform are considered. In operations about the mouth the patient is often deprived of the advantages of anesthesia through fear that suffocation might ensue from passage of blood into the larynx. The general opinion appears to be that such fear is exaggerated. Chassaignac advises us to watch for the moment at which, when the patient is recovering from the influence of the chloroform, consciousness awakes, while sensation is still in abeyance. If at this moment we make our incisions the patient feels no pain, and at the same time is sufficiently his own master to reject the blood which accumulates in his mouth, and to prevent its entrance into the air

passages.

On the importance of chloroform in operations on children, in facilitating the taxis of hernia, and the reduction of dislocations, it is unnecessary to speak. The uses of chloroform, applied externally, for the production of local anesthesia, the cure of itch, &c.; and as a solvent for different substances, specially gutta percha and camphor, are briefly noticed at the end of this chapter.

With regard to the administration of chloroform in operations on the eye, the generally received opinion is that it is applicable in

almost all cases except those in which the globe is largely opened, as in flap extraction of cataract. Here, the danger of prolapse of the iris with loss of vitreous, and perhaps separation of the retina and choroid, is so great, should vomiting occur, as to render the employment of chloroform extremely hazardous. We find, however, Jacobson advocating its use in cases of flap extraction as being perfectly free from danger, and as greatly facilitating the performance of the different steps of the operation. He says that by suitable regulation of the patient's diet, previous to the operation, and by the use only of pure chloroform, the occurrence of vomiting may be, in most instances, entirely prevented, and in those few cases where it does occur it may, by proper care on the part of the operator and his assistants, be rendered perfectly harmless for the eye. He supports his opinions by the results of 150 cases of flap extraction, in which chloroform was employed without ill effects.

The chapter on the uses of chloroform in midwifery practice is quoted almost entirely from Scanzoni. This writer disapproves of the administration of chloroform in perfectly natural labour, but in those cases in which it is necessary to moderate uterine action, and in most obstetric operations, he strongly advocates its employment. Of some novelty is his recommendation of chloroform as a means of warding off a threatened abortion or miscarriage. He relates a case in which uterine action had continued for some time, and the os was dilated to the size of a silver groschen. After inhalation had been maintained for half an hour the pains ceased entirely, the os quickly closed, and the patient went to her full time without further accident. She was a primipara; the threatenings of abortion had come on after a severe mental emotion; the period of her pregnancy is not mentioned. Scanzoni thinks also that in eclampsia chloroform is of service, not only in diminishing the severity and frequency of the fits, but also in helping to preserve the life of the child, which is generally lost, not by uremic poisoning of its blood, but by the interruption of the nutritive processes between the mother and child, produced by the spasmodic contraction of the uterine walls during the attacks. This spasm, the author thinks, can be mitigated by the use of chloroform.

The last chapter contains the history of the post mortem appearances of persons dead from chloroform inhalation. As has been already stated, with the exception of flaccidity and bloodlessness of the heart, the appearances are not characteristic of the cause of death.

On the whole, the work before us leaves, after its perusal, a somewhat unsatisfactory impression on the mind. Out of the mass of heterogeneous, and often contradictory, opinions contained in it, it is difficult to choose the good and true, and to reject that which is fanciful, or founded on insufficient observation. We think that those who wish to learn what is really known on the subject of chloroform will do better by consulting a book written by a single author, than one made up of cuttings from the writings of many. At the same time we would acknowledge the value of the present work as a contribution to medical bibliography.

A Practical and Theoretical Treatise on the Diseases of the Skin. By GEORGE NAYLER, F.R.C.S., Assistant-Surgeon to the Hospital for Diseases of the Skin, Bridge-street, Blackfriars 8vo. London: Churchill & Sons.

1866.

THIS Volume consists of 292 pages of large type, on toned paper; and, besides plates, to which we shall afterwards advert, it comprises twenty-two chapters, of which we shall endeavour to give a short analytical outline.

Chapter I." On the Anatomy and Physiology of the Skin"covers 21 pages, with an amount of matter which, in our opinion, is not at all necessary or desirable in a book of this kind. Any one who studies the subject of cutaneous medicine is presumed to know something of the anatomy and physiology of the skin, or at least to know that in anatomical and physiological works is the proper place in which to look for such information. If a man write a book on diseases of the heart, or of the liver, or of the kidneys, he is not expected to preface his treatise with an anatomical primer taken from the received writers of our own day.

Chapter II." On Psoriasis and Lepra"-treats of substantially one affection under the two names; and the mode of arrangement adopted by Mr. Nayler in each chapter may be well illustrated here. We first are told of the varieties of psoriasis, and then of its general characters and situation; its hereditary tendency and causes are next treated of; and here Mr. Nayler observes (p. 24):-"I am able to confirm the statement of Neligan, that psoriasis sometimes appears in the collateral branches of a family, while the immediate descendants are free from the disease. It is more common, however, to find it invade in the direct line." Mr. Nayler now proceeds

to discuss the relative frequeney of psoriasis in the two sexes; enters on the question of diagnosis; speaks of psoriasis annulata; syphilitic psoriasis; the absence of scales in syphilitic psoriasis; of ps. prominens; of the question of prognosis; and of treatment, particularly as regards salines, arsenic, and mercury used internally, and the local use of carbolic and nitric acids, and many other remedies. He recommends a lotion of carbolic acid, consisting of 14 grains of the acid, half an ounce of spirits of wine, and an ounce of glycerine, and a pint of water. Mr. Nayler does not omit to mention the use of baths in this disease; and he adverts to the question of diet; concluding Chapter II. with notices of the various varieties of psoriasis.

Chapter III." On Pityriasis"-does not contain anything new, and may, perhaps, be looked on as giving the views of Mr. Startin, Mr. Nayler's teacher. P. rubra and p. nigricans are given as having been "noticed by Cazenave, Startin, and others;" "but " he adds, "these are exceedingly rare." Mr. Nayler maintains the opinion that "pityriasis versicolor, or chloasma, is of parasitic origin.”

Chapter IV." On Icthyosis"-contains a variety of statistics respecting this disease. Under the head of "Icthyosis of the Tongue" we read (p. 62):-" Mr. Hulke has recorded a case of icthyosis of the tongue in a man, a patient at the Middlesex Hospital, who had it upwards of fourteen years. It differed from a corn in its tendency to increase at its margin. The treatment consisted in paring [sic] at intervals, as much of the upper part of the growth as could be removed without injury to the tongue." The condition of the urine in icthyosis is carefully noted, and tabular statistics of experiments, made by himself, are given by Mr. Nayler. They show that the specific gravity in such cases is low; while "notwithstanding the small rate per cent. of urea, the absolute amount in twenty-four hours is little altered in icthyosis; and this is somewhat remarkable when we consider that the skin, as a secreting organ, is reduced to the lowest possible limits, in the disease. This fact militates against the usually received theory of the elimination by the skin of urea (p. 65)."

Having disposed of diseases "of the squamous class," Chapter V. enters on the discussion of "papular eruptions," which, we are told, comprise lichen and prurigo; and include under the former, strophulus, or gum rash." Two pages of Chapter V. are occupied in describing lichen scrofulosus and lichen ruber, of Hebra, to whose article on the subject, in Virchow's Handbook, the reader is referred for further information.