ough and careful revision, and there has been added much new matter. There have also been added over two hundred excellent and prac tical illustrations, greatly increasing the value of the work. Because of the great amount of new matter it has been deemed advisable in this present edition to adopt a larger type page. This is a great improvement, rendering, as it does, the work less cumbersome. The book will be found to express the latest advances in the art and science of surgery. We certainly recommend it.

METABOLISM AND NUTRITION-Clinical Treatises on the Pathology and Therapy of Disorders of. By Carl van Noordan, Physician-inChief to the City Hospital, Frankfort-on-Main. Authorized American Edition. Translated under the Direction of Boardman Reed, M. D., Philadelphia. Part IV. The Acid Auto-intoxications. By Dr. Carl van Noordan and Dr. Mohr. Small 8vo. 80 pages. Cloth, 50 cents. E. B. Treat & Co., New York.

This is the fourth of van Noordan's monographs which has been translated and made available for English readers. In it the author gives a detailed study of the derangements of metabolism which result in an over-production of acid, thus deranging the proper degree of alkalinity of the blood. All physicians who treat chronic diseases intelligently and successfully recognize the fact that self-poisoning is a prominent factor to be considered and corrected; and that the acid forms of auto-intoxication are the gravest of all. Van Noordan's researches on this subject have been thorough and as presented in this book are of great practical value to the clinician.

GENERAL PATHOLOGY. By Dr. Ernst Ziegler. Tenth revised edition. Translated and Edited by Alfred Scott Warthin, Ph. D., M. D. Royal, 8vo, 784 pages, sumptuously illustrated by 586 engravings in black and many exquisite colors. Muslin, $5.00 net; Leather, $5.75 net. New York: Wm. Wood & Co.

Ziegler's Pathology is known the world over. It is a classic and has been an accepted authority in its line for a generation or more. The present volume is a translation by Prof. Warthin of the tenth German revised edition, which was published late in 1901 at Jena. Prof. Warthin has essentially everything in the original German work that could possibly be used in an American edition, being careful to give Ziegler's text as far as possible and making but few additions or changes. He has quite properly retained in this edition the entire bibliography noted in the German edition of the most important achievements of the past fifty years in pathology and pathological anatomy. Not only has he included all of this valuable portion of the

book, but has added some very important American references, particularly those of the last few years, thus bringing the work completely up-to-date.

We are safe in saying that there is no work published in the English language more thorough and complete, and at the same time more easily to be comprehended by the student of pathology than this work of Ziegler's. It is profusely supplied with illustrations, both in colors and in black and white, the text being thus made much more clear. The mechanical execution is exceptionally good, the paper being clear, non-translucent, and the press work of a high order. We can heartily recommend the book for the library not only of the specialist in pathology but of the general practitioner.

SAUNDERS' MEDICAL HAND-ATLASES.-ATLAS AND EPITOME OF OTOLOGY. By Gustav Bruhl, M. D., of Berlin, with the collaboration of Professor Dr. A. Politzer, of Vienna. Edited, with additions, by S. MacCuen Smith, M. D., Clinical Professor of Otology, Jefferson Medical College, Philadelphia. With 244 Colored figures on 39 lithographic plates, 99 text illustrations, and 292 pages of text. Philadelphia and London: W. B. Saunders & Co., 1902. Cloth, $3.00 net.

This excellent volume, the first attempt, to our knowledge, to supply in English an illustrated clinical handbook to act as a worthy substitute for personal instruction in a specialized clinic, is, indeed, a magnificent addition to Saunders' Series of Medical Hand-Atlases. The work is both didactic and clinical in its teaching, the latter aspect being especially adapted to the student's wants. A special and highly commendable feature is the very complete exposition of the minute anatomy of the ear, a working knowledge of which is so essential to an intelligent conception of the science of otology. As in all this series of atlases, the illustrations are beautifully executed in colors, and illuminate the text in a singularly lucid manner, portraying pathologic changes with such striking exactness that the student should receive a deeper and more lasting impression than the most elaborate description could produce. Further, the association of Professor Politzer in the preparation of the work, and the use of so many valuable specimens from his notably rich collection, especially enhance the value of the treatise. The work contains everything of importance in the elementary study of otology, and, without question, is a most valuable contribution to medical literature.

Never neglect to ascertain the cause of post-climacteric hemorrhage.

The Medical and Surgical Reporter.

Contributions are solicited upon any subject connected with the practice of medicine or the allied sciences, and the only restrictions placed upon them are that they shall be free from personalities and given to the REPORTER exclusively. The Editor of the REPORTER is not responsible for any opinion expressed by contributors.

Vol. XII.

MARCH, 1904.

Original Articles.

VERATRUM ALBUM-A LECTURE.

By J. C. Fahnestock, M. D., Piqua, Ohio.

No. 3.

The common name of this plant is White Hellebore, or European Hellebore. It is a perennial, herbaceous plant, and is found growing in the mountainous portion of Central Europe and Asiatic Russia. The central stem of Veratrum grows from two to four feet high; the leaves are alternate, broad-oval in shape, about six inches long, entire, sheathing at base, and strongly veined.

The flowers are in a large racemose-pinnacle, being yellowish white within and green without. The seeds of the plant are found in a threelobed capsule. It has a round, fleshy, blackish root about one inch in thickness, with rather large, long rootlets.

The root has a bitter acrid taste, is very poisonous, and in the fresh state it has a decided garlicky odor. This is the part used in the preparation of the tincture. I present a pen drawing of the plant. thinking it may be of interest to you. It is well and proper that we should be thoroughly acquainted with all the plants used in medicine.

Veratrum has a peculiar sphere of action among acute and chronic sicknesses. It has a comparatively wide range because its symptoms compare with many conditions found in different diseases.

The system of nutrition is acted upon in a marked manner. The vegetative system is affected in such a manner that the blood tends to separate into its primitive constituents; the liquid portions percolate through the tissues and because of this there is noted a profuse sweat, profuse serous vomiting, and diarrhoea. The liquid portion of the blood seems to fairly pour into the stomach and bowels, so much so that it astonishes you, and at the same time this fluid seems to be mechanically ejected from the body by way of vomiting and purging. This serous accumulation in the bowels has been compared to a genuine sweating of the mucous membrane of the bowels. This is a very

good illustration for there does not exist any inflammatory condition of the bowels.

The complaints of Veratrum generally come on suddenly and are similar in nature to a kind of shock or collapse. It is not strange to note great coldness; great prostration; rapid sinking of forces; icy coldness of the entire body; pinched nose; cold face; blue lips; cold breath; after such profuse evacuations of the body. Cold sweat on the face and especially on the forehead is a condition that stamps a Veratrum case. I repeat again, cold sweat on the forehead, is one of the conditions that runs all through a Veratrum case. This is one of the cold remedies. The body seems to melt away from the profuse discharges,-skin is cold and wrinkled, remaining in folds when pinched, with cold sweat on the forehead.

All the complaints in Veratrum are attended more or less with cold sweat on the forehead; every distress or trouble is attended with cold sweat on the forehead.

When we note the conditions found in Veratrum it is not strange that Hahnemann, the first prover of this great remedy, should recommend its use in certain forms of cholera when symptoms agree. The mental and moral states of Veratrum will be noted first as they are of the greatest importance in all remedies. Section 212 in the Organon reads:

"The Creator of therapeutic agents has also had particular regard to this main feature of all diseases, the altered state of the disposition and mind, for there is no powerful medicinal substance in the world which does not vary, notably alter the state of the disposition and mind in the healthy individual who tests it, and every medicine does so in a different manner."

We find Veratrum a great remedy for certain forms of mental troubles when symptoms agree. These mental troubles may come on with loss of memory. The mind refuses to act and the patient is only conscious of himself as in a dream. Vertigo is very pronounced, he is very dizzy, much worse in the mornings. When he awakes in the morning he feels dull, as if he had not slept enough, and on attempting to rise he is dizzy and exhausted, he falls back in bed in a half dreamy sleep with cold sweat on the forehead. Note the conditions as described by Hahnemann-"bland delirium, coldness of the body, open eyes with cheerful, at times laughing expression, talks about religious subjects, about vows to be performed; prays, thinks he is not at home." With this state he may be troubled with dizziness lasting several days.

Again we note raging, with heat of the body. He has fancied