years and a half previous to this outbreak submitted the water to chemical analysis and now exhibit to you the two reports which form a highly instructive contrast. I also show you the bacteriological reports upon the milk and water.

The result of examination of water from the Bethesda Home at Chestnut Hill shows:

8,100 bacteria per c.c. (Sample sent in Jan. 12, 1898.) The result of examination of sample of milk from the Home shows:

17,000 bacteria per c.c.

M. B. GARVIN,

Bacteriological Division of the Bureau of Health.

DR. ALFRED HAND, JR., presented a contribution to the THERAPEUTICS OF ENURESIS.

The patient, a boy of 2 years and 9 months, had been under treatment for some time without effect, although all the ordinary medicinal and hygienic measures had been tried. By mistake the child took four times daily a pill which had been prescribed for the mother, which contained ext. cannabis indica gr. 4, hyos cyamin gr. 1-400, and zinc phosphide gr. . The enuresis ceased within three days and has not returned. The pills were continued for two weeks with no ill effects.

D. L. EDSALL, Recorder,

330 South Sixteenth Street. Philadelphia, Pa.

LUMBAR PUNCTURE.

ACCORDING to Quincke, in the adult the spinal cord reaches only to the second, in children to the third, lumbar vertebræ, so that when the needle is thrust into the spinal canal through the arachnoid membrane below this point, it cannot pierce the spinal cord itself, but will find its way between the various strands of the cauda equina, and at the worst can only prick one of these cords. In performing the operation it has been found by most of the recorders better to place the patient horizontally on his side and to insert the coarse needle or fine cannula (which should be from five to eight centimeters in length) under the skin to one side, and thrust it upward and somewhat toward the central line, so as to enter the vertebral column near the middle. To this cannula is attached a rubber tube, to which in turn is connected a glass tube graded in centimeters; so that when this glass tube is held upward after the insertion of the needle, the internal pressure of the cerebro-spinal fluid can be measured, or by lowering the glass tube the fluid can be drawn off. The operation has been done a large number of times.

From a diagnostic point of view the value of puncture is to be found in its giving a clear knowledge of the pressure and the character of the cerebro-spinal fluid, but this knowledge has not been found to be of as exact diagnostic value as might a priori have been expected. The percentage of albumin is of some diagnostic value; if the albumin rises to one-fourth of a part per thousand, inflammation about the brain or spinal cord is indicated, but the indication is not a positive one, since in cerebral tumor and apoplexy without inflammation, according to Lenhartz, the albumin may amount even to so much as four parts per thousand. The specific gravity is without diagnostic meaning. The presence of an abundance of leucocytes indicates inflammation. The color of the liquid has significance, but with distinct limitations; if it be red from blood the existence of hemorrhagic pachymeningitis, or previous injury to the brain, is denoted. If the fluid be thickish, there is probably inflammation, but even in epidemic cerebro-spinal meningitis the flow, although it may be thick, has been found in some cases only turbid and in others as clear as water.-American Medico-Surgical Bulletin.

BOOK REVIEWS.

SEXUAL NEURASTHENIA [Nervous Exhaustion], Its Hygiene, Causes, Symptoms and Treatment. With a chapter on Diet for the Nervous, by George M. Beard, A.M., M.D. Edited with notes and illustrations, by A. D. ROCKWELL, A.M., M.D Fifth edition, with formulas. Published by E. B. Treat & Co., 241 West Twenty-third Street, New York City. 1898.

We are glad to welcome a new edition of this excellent book. There are not many changes. A new method of electrical treatment, styled depolarization, is advocated, and the arguments well supported. The chapter on diet and the formulas will also furnish many suggestions to the thoughtful physician who finds nervous prostration one of the most difficult diseases he has to treat.

THE PHYSICIAN'S WIFE, and the Things that Pertain to her Life. By ELLEN M. FIREBAUGH. Illustrated. Published by the F. A. Davis Company. Philadelphia.

The writer evidently speaks from experience and in a way to interest every physician and his wife. Wives do not tell many of their troubles, nor do we often realize their assistance. The book does not depict an ideal life or home, but it does present in a most charming manner an average doctor's home life. A careful reading by each "half" or aloud together will, we feel sure, make more successful, happier lives.

BOOK ON THE PHYSICIAN HIMSELF, and Things that Concern H's Reputation and Success. By D. W. CATHELL, M.D. New Tenth Edition (Author's Last Revision). Thoroughly revis d, enlarged, and rewritten. In one handsome Royal Octavo volume. 348 pages. Bound in Extra Cloth. Price, postpaid, $2.00 net. Philadelphia. The F. A. Davis Company, 1231 Filbert Street.

The thousands of physicians who have already purchased this book attest its value. It is difficult to give a comprehensive review of it. Its scope is wide, its style pleasing, its advice conservative and common sense. Many of the suggestions are axiomatic, but their presentation together, in a well indexed volume, is

novel. The special value of the book is to the young physician to whom in the first years of his practice there come so many puzzling questions of ethics, courtesy and economics which are far more difficult and may be far more important than those medical problems for which his training ensures a fairly good answer.

WHAT A YOUNG BOY OUGHT TO KNOW. The first book in a Self and Sex series to boys and men. By SYLVANUS STALL, D D. Vir Publishing Company, Hale Building, Philadelphia. Price $1.00.

This little book is designed to answer in an honest and reverent way the questions which arise in the mind of every boy concerning his own origin and how he came into the world. It tells just what every boy should be told about the design and care of the reproductive organs and in such a way as to beget reverence and inspire purity of thought and life. For purity, clearness and intensity this book is without a rival in literature of its class. The author understands his subject and handles it in a most scientific, artful and interesting manner. It is just such a book as physicians can heartily commend to parents, young boys and young men.

MANIPULATION OF THE MICROSCOPE. BY EDWARD BAUSCH. Illustrated. Third edition. Published by Bausch & Lomb Optical Company, Rochester, N. Y.

More and more we are learning that an American microscope, like a watch, attains as near perfection as any in the world. For the help and instruction of their rapidly increasing number of customers, Mr. Bausch has written this little book. It contains all that one needs to know to attain a practical working knowledge of this valuable part of a physician's outfit. All the parts are named and their use and relation explained. Most students and we fear many physicians, use their microscopes without this knowledge. The results are often seen in imperfect, unsati-factory observations and damaged instruments. We commend the book to all. It is not an advertisement of their microscope, but a simple yet scientific discussion of the subject.

THE ELEMENTS OF CLINICAL DIAGNOSIS. By PROFESSOR G. KLEMPERER, Professor of Medicine at the University of Berlin. First American from the seventh German edition. With 61 illustrations. Authorized translation by Nathan E. Brill, A.M., M.D., and Samuel M. Brickner, A.M., M.D. Published

by the Macmillan Company, 66 Fifth avenue, New York City. 1898. Price, $1.00.

The value of this little book, published at such a nominal price, lies in its clear statement of the methods employed by the distinguished German diagnostician. That there have been seven editions in as many years for the use of German students, is excuse enough for the translation. We believe it will find its greatest field of usefulness in the hands of the young physician or the student who have not yet formed their methods of diagnosis. The book seems complete in its scope, but lacks detail, for which of course its size is the cause. Of unusual excellence are the chapters on Diseases of the Nervous System, and on the Examination of the Urine, either of which is worth the price of the book to any physician.

THE WOUND DRESSER. A series of Letters written from the Hospitals in Washington during the War of the Rebellion. By WALT WHITMAN. Edited by Richard Maurice Bucke, M.D. Published by Small, Maynard & Co., 6 Beacon street, Boston. 1898. Price, $1.50.

No patriot can read unmoved these letters, written from the midst of the horrors of war. Nearly all are addressed to his mother and contain a touching personal element. To us, as physicians, accustomed to the perfection of modern hospitals, the book comes as a revelation. Doubtless the awful suffering and mortality would be now in some degree modified, but it could not be entirely avoided. A high tribute is paid to the faithfulness of the surgeons and the efforts of the government. Incidentally a strong argument is advanced for the value of personal contact in the treatment of the sick, a fact which busy physicians are apt to underestimate.

Vade Mecum de Pasologie et de Thérapeutique infantiles appliquées. By Dr. II. DAUCHEZ. Published by the Société d'Editions Scientifiques, 4 Rue Antoine-Dubois, Paris. Price, f.1.25.

French physicians are fortunate in having a series of these little books which may be carried in the pocket. This one presents in parallel columns the name of the drug preparation, the dosage proper for children, and the best form of administration, together with the commonest indications. The page opposite is blank, evidently for notes. Physicians who read French with even moderate ease will find the book useful and interesting.