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same style as the remainder of the book and detracts from rather than adds to the general value of the work.

If the author ever makes upon the stand some of the answers which he says he will give in the course of this medico-legal discourse he may find that there are other views. The bald statement that “when, instead of recovery, dementia develops (after cerebral trauma), there is always an underlying basis in the form of alcoholism, syphilis, epilepsy or arteriosclerosis” is contrary to a very large number of carefully made observations.

There are numerous illustrations in the work, but the majority of them are borrowed from other works.

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Bier's Hyperemic Treatment in Surgery, Medicine and the Specialties:

A Manual of its Practical Application. By Willy Meyer, M. D., and Professor Dr. VICTOR SCHMIEDEN. (Philadelphia and London: W. B.

Saunders Co., 1908.) Dr. Meyer, one of the authors of this work, has been a disciple of Bier and has used his methods of treatment for some fifteen years in New York, while Professor Schmieden has had the privilege of working in conjunction with Professor Bier as his assistant in the University of Berlin.

The work is one to which it is impossible to do justice in the limits of an ordinary review; it must be read, not only to obtain a correct view of the theories upon which Bier's treatment is based, but for a clear comprehension of his many and ingenious applications of the treatment (local hyperæmia) and the appliances which have been devised for special purposes of treatment.

Inflammation, the authors say, does not from a physiologic point of view represent in itself a diseased condition, but is a phenomenon indicating the body's attempt to resist a deleterious invasion. It naturally follows, therefore, that a process which is the natural attempt to resist the invasion of disease should not be fought but on the contrary aided and encouraged. The aim of Bier, therefore, is to “increase this beneficent inflammatory hyperæmia.” According to Bier it is a mistake to order the use of an ice bag at the beginning of an inflammation, but on the contrary one should attempt to increase artificially the redness, swelling and heat, three of the four cardinal symptoms of acute inflammation. The methods by which this artificial increase of the conditions associated with inflammation is produced are three: 1. By means of an elastic bandage or band. 2. By means of cupping glasses. 3. By means of hot air. The first and second produce passive or venous hyperæmia, the third active or arterial hyperæmia.

In applying these various means and particularly as to the first, it must be borhe in mind as of paramount importance that “the blood must continue to circulate, there must never be a stasis of blood.

The work is a most interesting one, and the authors deserve the thanks of the profession for putting into available and practical form the teach


ings of the originator of the method. It must be read and studied to be appreciated.

The Practitioner's Medical Dictionary. An Illustrated Dictionary of Medi

cine and Allied Subjects, Including All the Words and Phrases Generally Used in Medicine, with Their Proper Pronunciation, Derivation and Spelling. By GEORGE M. GOULD, A. M., M. D. (Philadelphia:

P. Blakiston's Son & Co.) To attempt a critical review or analysis of a dictionary would be an almost hopeless task. In the present instance such a task is unnecessary. Dr. Gould's dictionaries have an established fame from which nothing can detract, and to which but little could be added by any encomions of the reviewer.

The present volume is a very convenient work. It comprises over a thousand pages, but is printed on thin paper and is not therefore bulky and inconvenient. It is bound in leather with flexible covers, and will be found to be a convenient and useful addition to the practitioner's library table.

Illustrations of the Gross Morbid Anatomy of the Brain in the Insane.

A Selection of Seventy-five Plates Showing the Pathological Conditions Found in Post-Mortem Examinations of the Brain in Mental Disease. By I. M. BLACKBURN, M. D., Pathologist to the Government Hospital for the Insane, Washington, D. C., etc. (Washington: Gov

ernment Printing Office, 1908.) Dr. Blackburn has given to the profession in this beautifully executed series of photographs a most valuable contribution. He presents in this series of seventy-five plates accurate representations of the gross conditions found, in a form which permits not only the study of the plates in question but their comparison with conditions found in other cases.

No attempt is made, owing to the limitations of the work, to give a clinical history of the cases, or to connect the lesions portrayed with the symptoms observed during life. Neither are the plates presented as showing the essential morbid anatomy of any form of mental disease except paresis, and possibly senile insanity and arterio-sclerotic insanity.

We congratulate Dr. Blackburn upon the completion of a work upon which he has spent many months of conscientious labor.

Insomnia and Nerve Strain. By HENRY S. UPSON, M. D., etc. (New York some forms as something else. What the distinction and why the difference in designation he does not, however, make plain.

and London: G. P. Putnam's Sons, 1908.) The author tells us in his preface that among the insanities some groups due to changes in the organ of the mind are understood in course and nature. Others, called psychoses, aberrations that come alike to young and old, mysterious legacies, have all the terrors that attach to mystery and occur in forms of strange and violent contrast." This would seem to mean that he regards some forms of insanity as psychoses and

He states that the present attitude of the medical profession and the public toward the psychoses is almost one of Mahometan fatalism. This may be true as far as the public is concerned, but the signs of the times appear to us to indicate an opposite state of mind as regards the medical profession. Never has there been a period in which more active interest has been shown in the study, treatment and prevention of insanity. Dr. Upson appears to have reached the conclusion that the general professional belief is that insanity, with rare exceptions, is a disease without lesion. On the contrary we think the consensus of professional opinion is that insanity is but a symptom of some physical disturbance either primarily of the brain, or in its results affecting the brain and its functions. Indeed there are some who believe that the too general acceptance of a physical cause for mental disturbance has resulted in overlooking the occasional and important mental factors in the etiology of the psychoses.

The book is written with apparently two objects in view, one to announce the author's discovery of the “vaso-neural circuit,” the other to emphasize the influence of disease or malformation of the teeth, impaction, alveolar abscess and the like in the causation of various forms of insanity, and the care of these psychoses by dental manipulation and treatment.

The author has done well to call attention to the possible influence of dental maladies in the etiology of mental disturbance, and something of value will, we trust, flow from his observations. But one can but wish that in his little work he had given less time and space to the promulgation of his theories and more to a better clinical analysis of his cases. Such a course will carry more conviction than the recital of a series of cases labeled mania, dementia præcox, and what not, with no clear statement of the origin, course and treatment of the cases.




By FREDERIC H. PACKARD, M. D., Pathologist and Assistant Physician, McLean Hospital, Waverley, Mass.

The not infrequent occurrence of a psychosis in the course of Graves' disease gives rise to such questions as: Is there a relation between the Graves' disease and the psychosis? If so, what is that relation? Do the psychoses occurring under such circumstances correspond in character to the various recognized psychoses, or do they show such characteristics as should entitle them to special classification? What is the prognosis in such cases? etc.

With the hope of answering these and some other questions I have undertaken an analysis of 82 cases presenting psychoses associated with Graves' disease. A few cases were patients at the McLean Hospital; most of the cases were collected from the literature.

As is well known, the diagnosis of Graves' disease is frequently made without the presence of all the classical physical symptoms, and frequently when the symptoms are very slight, so much so at times as to make the diagnosis doubtful. Among the cases to be here considered, however, the physical symptoms were in each instance tolerably well marked.

The interest in Graves' disease has for many years been considerable, and its frequent association with a psychosis has been noted. Many articles with reference to its etiology, and especially with reference to its treatment, have been written, and have aroused considerable interest. Many of the authors, however, have been general medical men or surgeons, and the psychiatric

* Read at the sixty-fifth annual meeting of the American Medico-Psychological Association, Atlantic City, N. J., June 1-4, 1909.

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