with which he thinks epidemic meningitis can hardly be confounded, and (4) malarial fever, especially the so-called pernicious form. STILLE almost confines his differential diagnosis to typhoid and typhus fevers, entering at the same time into the proofs and arguments of the non-identity of either of these with meningitis. The chapter on the treatment of the disease evidently is that which presents the most intricate and difficult questions to decide. To judge of the value of special methods of treatment in a disease with an average mortality of 30 or 40 percent is a very difficult problem. The antiphlogistic method has been both recommended and condemned; the recommendations of the majority have always been for a limited and reserved use of antiphlogistic means. General bloodletting has been condemned, even in earlier days when the practice was in vogue and not "biased by the doctrines, or prejudices, whichever they may be, of the present day," as STILLE says. Local abstractions of blood by cups to the nape of the neck and leeches to the head have, with some, been in great favor, while others have seen no good effects from them. HIRSCH cautions against the use of copious local depletion in children, where it is apt to be followed by rapid and deep collapse. The use of cold to the head and neck is more universally recommended, especially in the earlier stage of the disease; cold affusions are also highly spoken of. Purgatives, especially drastic remedies, are absolutely condemned as injurious. Of blisters (which H. recommends) STILLE says that their utility in this disease is far from being universally evident, and: "Were we to judge according to our own experience alone, we should assign to blisters, applied to the occiput and nuchæ, a very high place among the remedies for certain forms of this disease; for we know that they relieve or remove pain, diminish delirium, spasm and coma, and therefore contribute as directly as any other remedies, if not much more so, to the favorable issue of the attack. But to accomplish these salutary effects of their use, they must not be employed when the disease assumes a malignant type, nor in any case after its constitution has become definitely fixed." Stimulants have been used in the earlier American epidemics, but most of the later authors make no mention of them even. STILLE regards "alcohol as a medicine which ought not to be included in the ordinary and systematic treatment of epidemic meningitis, but as a cordial to be held in reserve against those signs of failure in the power of the nervous system, which call for its administration in diseases of whatever name." Very general and very loud is the testimony in favor of opium in large doses. The greater number of European physicians, says S., prescribed it in doses quite too small to serve any good purpose. He was himself "in the habit of giving one grain of opium every hour, in very severe, and every two hours in moderately severe cases, and in no instance was produced either narcotism or even an approach to that condition." But smaller doses have also yielded favorable results. ZIEMSSEN, in cases of continued restlessness and moaning, gave 1-24-1-12 grain of morphine every hour or two and obtained "such excellent palliative effect, that it appears to us, next to cold, the most indispensable agent in the treatment of meningitis." In more urgent cases, he used the morphine hypodermically.—Quinia is utterly condemned, except in cases of complication by miasmatic poisoning, and as a tonic during convalescence. that On the alterative use of mercury in meningitis, the witnesses do not agree, and the diversity of opinion is great. HIRSCH denies any beneficial effects are derived from a mercurial treatment. STILLE thinks that the use of mercury is justified in that group of cases whose general expression is sthenic, with comparatively strong pulse, warm skin, severe pains in the head, spine and limbs, and marked tetanic phenomena. We think we have fairly represented the contents of the two books whose titles are placed at the head of this review. Let us add, finally, that STILLE'S book is, and will be for some time, the standard American authority on this interesting disease, and that we heartily recommend it to our readers. G. B. I. A REPORT ON AMPUTATIONS AT THhe hip-JoinT IN MILITARY SURGERY. BY GEORGE A. Oris, Assist: Surgeon and Bt. Lieut.-Col., U. S. A. (Surgeon General's Office, Circular No. 7.) Washington. 1867. 4to., pp. 87, with 9 plates. 2. A Contribution to the History of the HIP-JOINT OPERATIONS performed during the late CIVIL WAR. BY PAUL F. EVE, M.D., Professor of Surgery in the University of Nashville, Tenn. Ext. from Trans. Amer. Med. Assoc.) Philad., 1867. 8vo., pp. 17. 1. We were seldom more surprised at the exterior appearance of a book. Here are the finest paper and typography, and the very best illustrations by xylographs, lithographs, and chromos, such as a very large outlay only will procure. But an uncle as rich as Uncle Sam can afford to publish "regardless of expense." The question is, do the contents of the book correspond to the brilliant extérieur? Yes, and no. We answer yes respecting the report itself and the excellent wood-cuts, but no as regards the seven unnecessarily costly illustrations of healed stumps, of which five are chromo-lithographs of splendid workmanship-full-length portraits with much show of uniform, etc. The report itself, the work of Brevet Lieutenant-Colonel George A. OTIS, Asst. Surgeon U. S. A., not only displays the student and scholar, but bears evidence of a thorough knowledge of the subject. The historical and statistical part shows the minutest research in literature, and in the collection of the reliable facts the most indefatigable diligence is everywhere visible. The pathologico-anatomical descriptions of the lesions treated of and fully illustrated by the finest wood-cuts render the report very valuable; and the practical deductions and conclusions. drawn from the large number of amputations at the hip-joint made during the war, place Mr. Oris among the sound thinkers in surgery. We can not forego the pleasure of repeating in this place some statistical data, and the conclusions at which the learned author arrives. From the first authenticated amputations at the hip-joint by KERR (1774) and LARRY sen. (1793), up to the beginning of the war of the rebellion, the author enumerates a list of 108 cases, which he classifies as primary, i. e. performed within the first 20 hours after the injury,-intermediate, i. e. during the inflammatory stage, say to within two or three months,-secondary, i. e. at a period when the inflammation has subsided, and the lesions have become analogous to chronic disease,-and re-amputations, cases in which amputation had been previously performed. To this list are added the surprisingly great number of detailed cases of hip-joint amputations performed in our recent war-53, of which total number 16 recovered, and 3 are doubtful. Of these 53 operations, 34 were performed in the armies of the United States, and 19 in the rebel armies. In nineteen the operation was primary; eleven of them died within ten hours, three after two days, and two more after eight or ten days; only three recovered, "two so far that they were known to be in good condition, in one case two months, and in the other six months from the dates at which the operation was performed," and "one has survived the operation over four years, and is now in excellent health." The 18 cases included in the category of intermediate amputations resulted fatally. Of the 9 cases of secondary amputations, two recovered and seven died; and of the seven cases of reamputation, four recovered. The conclusions the author draws, we prefer to repeat in his own words: "1. We have learned that the PRIMARY operation for traumatic causes is not uniformly fatal, as has latterly been taught, and are enabled to define three conditions under which it should be undertaken, while two other conditions in which it may be justifiable are left sub judice." (p. 86.) These three, respectively five, conditions are the following (p. 77): (a.) "Few will deny that when the thigh is torn away by a large projectile so high up that amputation in the continuity is impracticable, it is incumbent upon the surgeon to regulate the wound by suitable incisions, and to disarticulate the head of the femur." (b.) "In the next place it may be safely asserted that when the upper portion of the femur is very extensively comminuted by solid shot or fragments of shell, and the soft parts are greatly lacerated in such proximity to the trunk as to forbid amputation in the continuity, the limb should be at once removed at the hip." (c.) "The third condition under which primary coxo-femoral amputation appears to be admissible in military surgery, is when, with fracture of the upper extremity of the femur, the femoral vessels are wounded." The conditions sub judice are thus worded (pp. 77, 78): (d.) "The observations of the late war afford but little data for the determination of the question propounded by M. LEGOUEST: whether, in the event of simultaneous division of the femoral artery and vein near the crural arch without fracture of the femur, if the surgeon has had the good fortune to master the hæmorrhage, it would be better to immediately disarticulate at the hip, or to temporize and to await the invasion of gangrene?" (e.) "Another question admitting of argument is: whether in those cases of fracture of the trochanters by conoidal musket balls accompanied by such extended longitudinal fissuring as precludes excision, the surgeon should not advise immediate ablation of the thigh? The experience acquired in the late war tends to determine this question affirmatively.” "2. Much evidence has been brought to controvert the prevailing doctrine that disarticulation at the hip is an exception to the general rule requiring all amputations deemed indispensable to be performed immediately, the eighteen intermediate amputations performed during the war having all resulted fatally." (p. 86.) "3. We have proved that secondary amputations at the hip for necrosis of the whole of the femur or for chronic osteomyelitis following gunshot injury, may be performed with as successful results as hip-joint amputations for other pathological causes." "4. It has been shown that when, after amputations in the continuity of the thigh, the stump has become diseased, re-amputations at the hip may be done with comparative safety." (p. 87.) 2. As of the 20 cases of hip-joint amputations given in Prof. EVE'S pamphlet 19 are embodied in full in Dr. OTIS' report, we can refer the reader to the latter; but we will not omit to mention that in Dr. EVE's contribution is also contained a tabular statement of 13 resections at the hip-joint, from which he draws one conclusion well worth remembering: "Resection doubly as favorable as amputation.” F. E. B. CATALOGUE OF THE UNITED STATES ARMY MEDICAL Catalogue of the Surgical Section of the U. S. A. Medical Museum. Catalogue of the Microscopical Section. Prep. by Bvt. Major EDWARD CURTIS, Asst. Surgeon U. S. A. Washington. 1867. 4to., pp. 161. In that enormous work,-the U. S. Army Medical Museum— the medical corps of the late war have laid the foundation of an |