per was electrotyped. This cuirass was usually perforated to allow of transpiration.

ity.

Thus an accurately fitted immobile corset was made, adapted to the deform

The use of extension previous to, and during the adjustment of the plasterof-Paris bandage, is considered by the author of the work before us an essential integrant part of the treatment. Dr. Sayre visited England during the last summer, and while there he made numerous applications of his method in several of the hospitals in London and elsewhere, and in the presence of some of the most distinguished physicians and surgeons of Great Britain.

The volume we are noticing was published in London, and contains the history of his first employment of the dressing, and the narration of many cases in which it has been used, both in this country and in England.

It was towards the end of the year 1874 that the first full plaster dressing was applied. The majority of the cases cited occurred during the year 1876 and 1877. The principle upon which this device is founded is undoubtedly the true one, namely, that upon which we act when treating a fractured bone. The diseased spine should be kept immovable, and it should be relieved of all superincumbent weight.

Those who have had much experience with this disease have constantly had occasion to remark the relief which is afforded by support of almost any description. Any arrangement which will brace the trunk is most gratefully received. A simple bandage wound around the body is acceptable, and the firmer the support, the greater the relief obtained. This fact accounts for the degree of success, often only temporary, which attends the use of the numerous instruments which have been devised for the treatment of spinal disease. The best of those which are intended to be worn while the patient is moving about are based, in accordance with the principle above stated, upon the theory of anteroposterior support combined with an attempt to prevent motion and pressure.

A description of an apparatus constructed to fulfill these three indications was published by the writer of this review in 1858. This instrument, with modifications from time to time, was constantly used by him for some years previous and subsequent to that date, and, thus modified, is employed to the present time, in cases adapted to that method of treatment, and especially in the convalescent stages of the disease. More recently (in 1863), Dr. C. F. Taylor of New York described an instrument formed upon the same principles and now known by his name.

It appears to us probable that Dr. Sayre's "plaster-of-Paris jacket " may prove to accomplish the indications of immobility and relief from superincumbent pressure better than any other appliance, allowing locomotion, which has hitherto been devised. That it will supplant all other treatment, and that it is applicable to every case of caries of the spine, and in all its stages, surgeons who have experienced or have witnessed the remarkable results of absolute rest will be slow to believe. By rest is here meant not simply lying in bed, with occasional sitting up, or rising on the elbow, and other movements, such as circumstances may seem to require, but complete physiological rest,- rest, therapeutic in its influence, and, combined with extension so applied as not

only to prevent all movement of the diseased vertebræ, but also to render pressure upon the inflamed or carious surfaces impossible, and this united with such local applications as the case may require and with a thorough hygienic and constitutional régime; a rest from which the patient rises fat, with red blood, with restored health, and often without deformity.1

Dr. Sayre's surgical skill and his scientific application of a fertile, inventive genius command our respect. His enthusiasm in the branch of surgery to which he has chiefly devoted his time, talent, and energies is well evinced by the ardor with which he has advocated, and consequently extended, his treatment of Pott's disease.

There is one point connected with this treatment to which we have not referred. The skin is an important organ. The healthy performance of its functions is of momentous consequence in the role of general health. In an æsthetic, as well as a sanitary point of view, the prolonged occlusion of so large an extent of cutaneous surface from the beneficent influences of air and water, with the unavoidable accumulation of secretions, is a consideration not to be overlooked when contemplating the adoption of the plaster-of-Paris bandage in any particular case.

The method of treatment for the exposition of which the volume before us was written is of recent birth. It is only after prolonged experience, on an extended scale, in the hands of skillful surgeons, and under the eye of the medical public, that this new appliance will find its true place among the resources of our profession, in the treatment of spinal caries, or in certain stages of the disease.

We are using the " plaster-of-Paris jacket" in cases and under circumstances to which it is deemed peculiarly applicable. The results of these investigations will be made public, after sufficient time has elapsed to enable us to give a fair analysis, and to form a correct judgment on the merits of the treatment in the complaint we have been considering.

The latter portion of the volume is devoted to rotary-lateral curvature of the spine.

The treatment of this affection by the same dressing as that which is applied in vertebral disease, is advocated. On this point we feel obliged to differ in toto from our author.

The two complaints are far removed from each other pathologically; and also in ætiology, in symptoms and in results. The treatment of lateral curvature, in our opinion, should be for the most part utterly dissimilar, in fact the opposite, to that which is appropriate in inflammation or caries. One is a disease of the bone, or of fibro-cartilage, or more frequently of both tissues. The other is a disturbance of equilibrium, arising sometimes from habits of malposition, but in far the larger number of instances it originates in muscular and nerve debility, or from a combination of these causes.

Lateral curvature of the spine, generally, perhaps always, complicated with rotation, when unconnected with disease within the chest, is sometimes

1 The writer of this notice intends to prepare for the press a paper upon Caries of the Spine in which his experience and views will be given more at length than is admissible in a brief review like the present.

presented to our notice in a person young, healthy, and even robust in appearance. Under such circumstances, it is evident the complaint does not originate in debility. It undoubtedly arises from some vicious habit of standing, walking, or undue use of one arm, or from habitually carrying a weight on one side, as in resting a child on one hip, etc. In another class of cases, and as we have previously said, this is far the larger class, the patient has thin, weak, yielding muscles, is anæmic, nervous, and is otherwise undertoned, often without being decidedly an invalid. The cause of the spinal curve is evident, and it often seems to be a matter of chance in which direction the chain of bones yields. In still others, the curve may be traced to a combination of the above mentioned causes.

Such being the etiology of lateral curvature, our local treatment should be as diametrically opposed to that which is to be pursued in Pott's disease as is the pathology of the two affections.

We can hardly imagine any combination of circumstances which would induce us to incase a young, growing girl, in the early stages of lateral curvature, in plaster-of-Paris. In those cases to which we have referred as arising from general debility, we think the curvature can be relieved more thoroughly, more permanently, and more naturally, by other methods than by inclosing the trunk in unyielding walls, where healthy play of the muscles is almost, if not quite, impossible, while at the same time we are not prevented from employing local as well as general tonics. The very reasons which may, under certain circumstances, render such a course appropriate, where we have to deal with diseased bone, will hold as an unanswerable argument against its employment in lateral curvature. The small amount of special spinal exercise afforded by "self-suspension," for a few moments twice a day, as advised by Dr. Sayre, will not obviate the effects of inaction of muscle, ligament, and bone. Absorption of adipose tissue and muscular atrophy must inevitably follow. In such cases every hygienic influence that we can command should be called upon to assist in removing the constitutional debility, as well as the local affection.

The patient should not be debarred, by any appliance which may be used to remedy the curvature, from the great, the all-important benefit to be derived from massage and friction, from bathing, and from the active and varied use of the muscles attached to the spine.

In those cases where the patient is in good health and flesh, the effects of confinement and pressure above alluded to must be still more apparent. In the more advanced stages our objections would still hold good, and it is only in confirmed scoliosis, where a simple, firm, cheap support is required to enable the patient, with greater ease, to pursue his or her customary avocations, that we should be willing to recommend the employment of the plaster "jacket."

While in conclusion we decidedly express our opinion as adverse to the application of the plaster-of-Paris bandage in scoliosis, we think in some circumstances, as one of the remedial agents in carious cyphosis, its use will prove a valuable resource. For its introduction to the profession in these cases, although servicable, perhaps, in a more limited sphere than was originally intended, we are indebted to Dr. Sayre.

B. B.

REMSEN'S THEORETICAL CHEMISTRY.1

In this little book of two hundred and twenty-eight pages we find the most complete explanation of the new chemical nomenclature which we have seen. The work is divided into two parts. The first consists of a "general discussion of atoms and molecules," and the second explains the "constitution or structure of chemical compounds." In the first part the history of the development of the atomic theory and the reasons which lead to the present distinction between the atomic and molecular weights of an element are briefly but clearly given. Also the valence or atomicity of the elements is explained as clearly as possible in the present state of our knowledge. The second part is devoted to the explanation of the molecular structure of chemical compounds, structural formulas being discussed at considerable length.

We most heartily commend this book to those readers who wish to know "exactly upon what basis our conceptions of chemical constitution rest," since they will find here in a small space those facts and explanations which elsewhere are only to be found scattered through various works and in a form much less easily comprehended.

W.

THE FUTURE.

We have a few words to say to our readers about our plans for the future and some of the changes which have taken place with the advent of a new year, and we must avail ourselves of this opportunity to allude first of all to the valuable services of our associate, Dr. Thomas Dwight, who retires from the position of editor, so ably filled by him for five years. The many changes which the JOURNAL has undergone during this, a not uneventful, period in its history, and the favorable results which have followed therefrom, are in no small degree due to his able management and his courageous stand in delicate questions involving professional interests or public welfare, where his power for satire or praise and his ability in argument have forcibly displayed themselves, and have contributed to the increased influence exerted by the JOURNAL upon the community as well as the profession in which it circulates. We shall still have the benefit of his services in the department of anatomy. For the details of other changes we would refer our readers to the publishers' announcement. It will be seen that the JOURNAL means to keep abreast of the times, and to anticipate rather than to follow the metamorphoses which medical periodicals in this country are slowly but surely undergoing. The recent termination of the brilliant career of the British and Foreign Medico-Chirurgical Review is a significant fact. The taste of the present day is undeniably in favor of weekly rather than quarterly or even monthly issues of brief and varied contributions, giving the latest ideas at the shortest notice. A good journal should also be cosmopolitan. This is a feature which, we are glad to see, is becoming

1 Principles of Theoretical Chemistry, with Special Reference to the Constitution of Chemical Compounds. By IRA REMSEN, M. D., Ph. D., Professor of Chemistry in the Johns Hopkins University. Philadelphia: Henry C. Lea. 1877.

more characteristic of our prominent journals, and is one which we propose to keep well in view. We trust that our efforts in this direction will be seconded, not only in more distant parts of the country, but also nearer home in New England, where the large number of medical organizations offers a fruitful field for clinical observation. All our large cities will be represented to an extent such as space will permit. These, in brief, are our aims for the future we trust that it may prove an eventful and beneficial one to medical literature in this country, and that the time is not far distant when we shall have no longer a series of sectional magazines confined to narrow limits, and when the tidal wave of miscellaneous periodical literature which is now sweeping over us shall have subsided that there will be left to us a few prominent national journals, read in every State, and serving as a common ground where every American physician may meet and profit by the work of his fellow countrymen.

MEDICAL NOTES.

There are thirteen vacancies in the medical corps of the army, which will be filled by the appointment of such persons as may pass a satisfactory examination before the board now in session in New York city, consisting of Surgeons Joseph B. Brown, Joseph H. Bell, and C. H. Alden, United States Navy. This board, which met on the 7th of November, will probably remain in session until the latter part of February, to select suitable persons for appointment to the corps.

- Dr. Telkampf, the military medical expert in New York for the German empire, states that he has been examining a large number of Germans lately and issuing certificates to them showing their physical condition. This was done for the benefit particularly of those subjects of the Emperor William who do not intend to become citizens of the United States, and who expect some time in the future to return home. Under the old rule it was necessary for German subjects to appear in person for examination before the home medical authorities, but recently that rule has been relaxed, and now a certificate issued here is accepted by the home government, and saves the subject from fine and imprisonment if he returns to Germany.

Since the hard times set in, Dr. Telkampf has had numerous applications from Germans to be sent home for military service, preferring life in the camp to lack of work and food in America; but he says he has no provision to furnish transportation. Many applicants for examination resort to expedients of all sorts to secure" inability " certificates, and when they fail they become very indignant. The doctor says that under the laws of Prussia, "if the subjects in this country do not return, they are held to be Prussian subjects who have run away from conscription, and at any time in the future, if they return, they are liable to arrest. If in the mean time they become American citizens their offense is overlooked somewhat, but complications may arise at any time."

Dr. Telkampf is a citizen of this country, and has held the position of medical examiner for the Prussian government for over three years, and has issued hundreds of certificates during that time.