cells of a connective tissue nature within the glomerulus itself. Their conclusions are the result of an investigation into eight cases showing various degrees of glomerulonephritis. They distinguish three main varieties, viz., desquamative, proliferative, and hæmorrhagic.

The first important change noted is in the basement membrane, which shows thickening and fibrillation. In the gaps between the fibrils appear wandering cells. The structure shows a remarkable persistance, and remains after all epithelium has been desquamated. As previously mentioned, it only lines Bowman's capsule, and is not continued on to the glomerulus itself, at any rate in adult life.

The second change mentioned is a desquamation of the epithelium covering the glomerulus and lining the capsule. The process usually commences with a swelling of the cells, which become cubical in the case of the cells lining the capsule, and club-shaped in the case of the cells covering the capillary tuft. The cell protoplasm becomes granular and vacuolated, and the nuclei show caryolysis and caryorrhexis. Later, the cells become desquamated, and lie in the space along with leucocytes and the debris of red blood cells. After being thrown off in this way, the cells show all stages of degeneration up to complete disappearance. Nauwerck has described cells similar in character as being found in the urinary sediment in such cases, clinically.

Another important change is proliferation of these epithelial cells. This has been denied by some observers, who consider that the cellular increase is simply the result of desquamation. Herring considers that the change is chiefly observed in the cells lining the capsule. Fichera and Scaffidi have observed the change in the cells covering the tuft. In support of this proliferation, the last-mentioned authors advance their observation of the occurrence of layers of cells within the capsule, also of cells partially attached to the basal membrane and showing a normal appearance. This cell accumulation becomes vascularised, and ultimately contracts.

The question arises as to whether this cell multiplication takes place by means of direct or of indirect division. Fichera

and Scaffidi have never found true karyokinesis, although they occasionally observed appearances suggestive of it. They conclude that the process takes place by means of direct division. In support of this, they advance their observation of the occurrence of cells rich in protoplasm with two or more nuclei, and sometimes nuclei with a constriction in the centre apparently in the act of dividing. This proliferative process does not occur all over at the same time, nor does it occur in all the Malpighian corpuscles to the same extent.

The chief changes observed within the capillary tuft werediminution in the nucleated elements, increase in these elements, thrombosis, hyaline degeneration, and necrosis of capillary loops. As regards the first of these, sometimes the nuclear diminution was very evident, there being left behind simply an occasional leucocyte or endothelial cell. The vessel loops consisted of fine homogeneous structureless walls. This diminution occurred chiefly in those cases where there was a marked desquamation of the epithelium covering the tuft. This suggested the explanation that the two arose from the same cause, and that the absence of nuclei within the glomerulus was occasioned by the throwing off of the epithelial cells which occur between the lobes of the capillary tuft. On the other hand, in cases of long-continued inflammation, one finds a marked increase in the nuclei. some, this is due to a multiplication of pre-existing cells of a connective tissue nature. The authors, however, reject this explanation, as they do not believe in the existence of such cells. They also reject the explanation that the phenomenon is due to a multiplication in the endothelial cells of the capillaries. According to them, it is to be explained by an excessive accumulation of leucocytes.

According to

JAMES MILLER.

REVIEWS.

A Practical Guide to the Administration of the Nauheim Treatment of Chronic Diseases of the Heart. By LESLIE THORNE ABRAM, M.D. Durham. London Baillière, Tindall, and Cox.

THIS is a short handbook for those who wish to prescribe the Nauheim treatment in England. Experience has shown that the method followed at Nauheim requires modification when employed by patients who are unable to travel abroad.

The author obtains his best results in cases of dilated irritable heart such as may follow influenza, the symptoms being palpitation, dyspnoea, insomnia, vertigo, cardiac pain, and lassitude. The first bath (containing four to five pounds of Droitwich salt, and five to six ounces of calcium chloride) is given for three to four minutes, at 97 to 98 degrees. The pulse is noted before and after. The patient goes to bed, and remains at perfect rest. These baths are continued on two consecutive days, while on the third day the "Schott exercises are given instead of the bath. Later, a bath is taken three days running; the strength of the bath in suitable cases may be increased by one pound of salt and one ounce of calcium chloride. The length of immersion is increased by one minute daily. The temperature is lowered from 97 or 98 degrees to 94 or 93 degrees. Cases unsuitable for this method of treatment are those of alcoholic and syphilitic nature, or having other forms of myocardial degeneration. Several cases are given in support of the author's method.

Nouveau Formulaire Magistral. By A. AND G. BURCHARDAT. Paris Félix Alcan, 108, Boulevard Saint Germain.

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THIS is a publication which corresponds in some degree to the Companion to the Pharmacopoeia." It gives the usual pharmaceutical formulæ and methods of preparation. French

methods of prescribing differ considerably from ours, especially in their palatability, and valuable suggestions may be obtained for prescribing, especially the more active drugs and those having a strong or nauseous taste. The art of making up "nice" medicine instead of nasty is of more importance than the junior practitioner is always aware. Taking iron as an example, the methods given in the Formulaire Magistral" for making it up are varied and palatable. Other portions of the work refer to diet in all possible circumstances. We most particularly notice the diet tables for diabetic patients. Mineral waters and springs in all parts of Europe are described. We can imagine the French "Formulaire " as extremely useful in getting over difficulties in refined prescribing.

Nervous and Mental Diseases. By ARCHIBALD CHURCH, M.D., and FREDERICK PETERSON, M.D. London: W. B. Saunders and Co. Fourth Edition.

WE have already had an opportunity of reviewing this work. A new edition shows that the opinion then formed was correct, namely, that Drs. Church and Peterson's text-book is of substantial value to the profession. Revision of the book has been thorough, and we notice the addition of much new matter, and many additional illustrations. The healing of nerves—a subject on which some light has been thrown by recent investigations is among the added matter. There are many interesting clinical conditions with an obscure pathology to be met with in practice. Their indefinite nature is perhaps the reason why they do not find a prominent place in ordinary text-books, or do not arrest the student's attention. Consequently, when a case is met with, the disease is not recognised, and so an opportunity for further clinical observation is lost. To this division belongs the large class of tropho-neuroses so-called, acroparesthesie, intermitting limping, angioneurotic edema, and adiposis dolorosa. This group of diseases is particularly well described by Drs. Church and Peterson.

Advances in neuro-physiology have brought to light many interesting phenomena in connection with some of the commoner lesions. Thus the recognition of astereognosis as a sign of lesions of the sensori-motor cortex is important, and supports recent views taken of the rôle of the cortical portions of the brain. This and other signs are fully described. The Tics" are a curious and difficult group of diseases, concerning which we require to learn more. The chapter given to them by Drs. Church and Peterson is too elementary.

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Dr. Peterson is responsible for the section on Mental Diseases. It is almost a pity to unite these and the more general diseases of the nervous system in one volume. At the same time, the 250 pages given to them contain clear and well-authenticated information. We can cordially recommend the book to the advanced student of medicine.

MEDICAL PREPARATIONS.

WE have received a sample of Nestlé's Milk Food for Infants. The food is prepared by first pasteurising the milk, and then condensing it and drying it, after admixture with ground wheaten biscuit, into which the greater part of the starch has been converted into maltose and dextrin. quantity of cane sugar is then added. The composition of the food is as follows:

Fat

Proteids

A small

5.26

14.02

The food, prepared according to the directions given, is

palatable, and should afford a valuable addition to the list of infants' foods.