SiVi ft' THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES GIFT Dr. Emil Bogen wmm. VCitJS//^ ^^IVyiVibLU^ .Km^ v/v>nA!N'! *1i ivaHn-# AHVHHl ■mym/A AOS-ANG THE NEW SYDENHAM SOCIETY. INSTITUTED MDCCCLVIII. VOLUME XLVI. CLINICAL LECTURES PULMONARY CONSUMPTION. FELIX VON iJ^IEMEYER, M.D., DIETCTOR or THE MKBICAL C'LINIQUE, AND PR0FE6S0R OF CLINICAL MF.PICINE IX THE rNIVKRSITY OF TUBINGEX. TRANSLATED, BY PEEMISSION OF THE AUTHOR, FROM THE STICOND GERMAN EDITION, BY C. B^IJMLER, M.D., MEMBER OF THE ROYAL COLLEGE OF PHYSICIANS, ASSISTANT-PHY'SICIAN TO THE GEPMAN HOSPITAL, AND TO THE HOSPITAL FOE DISEASES OF THE CHEST, VICTORIA PAPK. THE NEW SYDENHAM SOCIETY, LONDON. MDCCCLXX, LONDON : Printed by W. Clinkskel, 70, Paradise Street, Eotherhithe. M5'6"5'c \870 PREFACE. The lectures contained in the following pages were first published in the "Berliner Klinische Wochenschrift " of 1866 and 1867, by Dr. Ed. Ott, Professor Niemeijer's assistant. They were soon afterwards reprinted in a collected form, and have since, in two editions, found a very wide circulation on the Continent. In presenting them now to the Members of the " New Sydenham Society," it need hardly be stated that, since their first appear- ance, the " thorough reform of the doctrine of pulmonary con- sumption" which Professor Niemeyer then called for has been inaugurated. The last few years have been distinguished by great activity in this very field of pathology, and most important discoveries have been made. The views insisted upon by Professor Niemeyer have, almost to their whole extent, been confirmed by the results of recent investigation. But the renewed study of the whole question has led also to a more just appreciation of the works of former observers. In this coimtry the labours of Thomas Addison, Avhich had almost been forgotten, and which had remained entirely unknown on the Continent, have been brought to light again, and show that already at a period when Laennec's teaching had just commenced to dominate over the patholog}' of lung diseases, an independent observer arrived at, and firmly held, the opinion which in more recent times was established by Reinhardt, VircJioio, and his disciples, and which forms the key- note of these lectures, namely that, to use AddisorCs own words, " i7]flammation constitutes the great instrument of destruction in every form ofphtJdsis. ' ' The other chief point of Professor Niemeyer'^s teaching. VI PEEFACE. namely the theory first brought forward by Buhl in 1857, con- cerning the relationship of miliary tubercle to cheesy products, which he adopts with some modifications, has, since the appear- ance of these lectures, not only been most ably supported by the clinical and pathological observations of C. E. E. Hoffmann^ but has been strikingly confirmed by the results of the experimental researches which were started by Villemin, and which have been worked out by Simon, A. Clarky JBurdon Sanderson, and Wilson Fox in this country, by Colin, Chauveau, and others in France, and by Lehert, Walde7ibnrg , Cohnheim, and others in Germany. It is now an established fact that miliary tubercles can be artifi- cially produced in animals by the inoculation of cheesy, tuber- cular, or purulent matter, or by simply establishing a deposit of pus in some part of the body. By the results of these experiments, BuhVs theory has both been narrowed and enlarged : the local nature of the infection, upon which Niemeyer has already laid great stress in these lectures, has been placed more in the foreground, and, tubercular infection having been divested of its specific nature, tubercle may be said in some sense to have lost some of its special malig- nancy, while, on the other hand, the sharp distinction made by Niemeyer between the inflammatory processes and tubercles has been considerably qualified by the fact that both may result from infection. But, however the clinical aspects of consumption may ultimately be affected by the further development of these studies, the picture here drawn, by Professor Niemeyer, of pul- monary phthisis, and more especially the principles derived therefrom for its treatment, will lose none of their force for a long time to come. These lectures have, therefore, although a few years have already elapsed since their first appearance, lost nothing of their importance, and may form for the Members of the Society a suitable accompaniment to Addison'' s papers on the same subject in one of the previous volumes. On the part of the Translator, a few notes have been added PEEFACE. vu in explanation of terms exclusively or differently used in German medical nomenclatm'e. Some alteration from, and addition to, the original has, with Professor Niemeyer''s concm'rence, been made at page 39, by inserting some sentences from a more recent paper by the Author. In conclusion, I have to express my best thanks to my friend and colleague. Dr. A. B. Shepherd, for having kindly revised the manuscript before going to press, and for much assistance in correcting the proof-sheets. C. B. FiNSBURT Place North, May, 1870. CLINICAL LECTURES PULMONARY CONSUMPTION. There is no subject in the whole range of pathology which more lu'gently requires a thorough reform than that of Pulmonary Consumption. In this field, pathological anatomy is much in advance of clinical medicine. The term "pulmonary tuber- culosis" being still the one most commonly used for pulmonary consumption, shows that the majority of the physicians and clinical teachers of the day abide by Laennec's doctrine, and recognise but one form of pulmonary phthisis, namely, tubercular phthisis. The dangerous tenets oi Laennec'' s doctrine, "that pul- monary j^hthisis is a constitutional disease, that it never can develop itself out of acute or chronic pneumonia, or take its rise from a bronchial hjemorrhage, or from a neglected or protracted cold," are up to this day taught in the medical schools as undisputed truths, and have in practice a most pernicious effect on the pre- vention and treatment of phthisis. Laennec's dogma, that every form of pulmonary phthisis is caused by a specific new growth (une espece particuliere de i)ro- duction accidentelle), and that the cavities in the lung take their origin alone in the softening and the evacuation of this groAvth, "svas simply a patlioloylcal hypotliesls, which, by the more recent researches in the field of pathological anatomy, has been entirely I'efuted. This being the case, the conclusions drawn from it b}' Lamnec have lost all support, and the assertions which are still so frequently repeated, that a bronchitis out of which phthisis is developed is not to be considered as a primary genuine cold, B 2 PULMONARY CONSUMPTION. but as a secondary catarrh caused by the irritation of the lung by already existing tubercles, and that the same explanation must hold good for those attacks of pneumonia and hgemoptysis which so frequently precede phthisis, prove that in this field medical practice has almost entirely ignored the progress made by pathological anatomy. The error in which Laennec and his followers were entangled did not consist in their regarding tubercle as a new growth, but in the fact that they considered those condensations of lung- tissue, which have quite a different origin, to be also products of a development of tubercles. This confusion originated chiefly in the cheesy/ metamorphosis of the originally gray and transparent tubercle being accepted as one of its specific peculiarities, and as a sign from which the tubercular nature of any substance which underwent this transformation might be inferred. From this point of view, one was justified in regarding the extensive consolidations in phthisical lungs which were found side by side with miliary tubercles, and which, having been at first gray and transparent, had afterwards become yellow and cheesy, as a diffuse growth of tubercles, or as extensive infiltrations of the lung with tubercular material. But, since pathologists, especially Virchoiv, have shown that substances of the most varied kind which have not the least relationship to tubercle, such as older cancerous tumom's, lymphatic glands swollen by hyperplasia of their cells, hsemorrhagic deposits, encapsulated masses of pus, etc., undergo the very same cheesy transformation as miliary tubercle, the fact that those diffuse consolidations of the lung become yellow and cheesy can no longer be admitted as a proof of their tubercular nature. Laennec' s whole theory of infiltrated tuberculosis, or tubercular infiltration, which was sup- ported by that criterion alone, has thus lost its foundation. In the present stage of science there is but one kind of tubercle — miliary tubercle, and but one form of tuberculosis — miliary tuberculosis : and all those changes which, since Laennec, have been designated " infiltrated pulmonary tubercle," are the product of chronic, especially of catarrhal, pneumonia. It is to be hoped that the terms " to undergo the tubercular change," " infiltrated tubercle," " tubercular infiltration," which have caused so much confusion, and which I have zealously opposed for years, will at last be given up. PATHOLOGY. 3 But the doctrine of miliary tubercle has no less than that of infiltrated tubercle received a blow by the progress of patholo- gical anatomy. It has been found that many formations which, at first sight, appear to be miliaiy tubercles, and which formerly were commonly considered as tubercles, are, on more <3areful examination, found to be transverse sections of bronchi with cheesy contents, or whose walls are thickened and surrounded by alveoli filled with a cheesy infiltration. If such mistakes be avoided in judging of the post-mortem appearances, we arrive at a result which, it is true, is in glaring opposition to the views prevailing in practice, namely, that in very many cases there is not a single tubercle found in phthisical lungs, and that the consolida- tions and destructions of the lung are caused alone by inflamma- tion leading to induration and softening. Virchow, whose merits in this field of pathological research are very great, goes, however, certainly too far in asserting that even the doctrine of miliary tuberculosis is almost entirely founded on errors, and that almost all the alleged miliary tubercles of the lungs are bronchitic, peribronchitic, and pneumonic deposits. It is by no means of rare occurrence for the same transparent gray granules — which in acute miliary tuberculosis are scattered in great number through the lungs and most organs, and whose tubercular nature can hardly be questioned — to be met with also in phthisical lungs. But no less should we consider as tubercles those yellow cheesy deposits which occur unmistakably in the form of miliary granules, when by their side there are also pre- sent in the lung those gray miliary tubercles, and if also in other organs gray and cheesy tubercles are found. The proof that those cheesy granules are not tubercles, but the product of vesi- cular pneumonia, cannot be established, as we have no criterion by which to distinguish a cheesy tubercle from a cheesy miliary granule of inflammatory origin. I repeat that, even leaving out of the question the tuberculosis of the bronchial mucous mem- brane, I cannot admit that in the lungs of phthisical patients tubercles do but rarely occm*. But still, the relation of the tubercles to the consolidations and destructions of the lung, i. e. to phthisis, even in such cases in which they occur side by side, is, as a rule, quite a different one from that which the faculty teaches us to regard as their normal or usual relation. If at every autopsy of this kind wc put B 2 4 PULMONARY CONSUMPTION. to ourselves the question at what j^eriod of the disease the development of the tubercles may have taken place, an inves- tigation which is not influenced by inveterate prejudices leads to the conclusion that the tubercles bi the majority of cases are clearly of recent origin, and have complicated the pulmonary phthisis when it was already in an advanced stage. With regard to intestinal and laryngeal tubercle it has ahvays been an accepted fact that, as a rule, it arises only as a secondary complication of an already existing pulmonary phthisis. I am convinced that the same in- terpretation holds good alsoforthemajority of cases of pulmonary tubercle ; and I have repeatedly had the satisfaction of receiving from former pupils reports of patients " who, after having suffered from phthisis for years, had at last become affected with tubercles." In cases of this kind, the tubercles either take no part at all, or only a very secondary one, in the destruction of the lung. As a rule, death occurs before any considerable soften- ing and expectoration of single or aggregated tubercles has taken place. In spite of the presence of tubercles in the lungs, this form of pulmonary phthisis cannot therefore be strictly called tubercular phthisis. In only a comparatively small number of those cases in which, besides the products of chronic pneumonia, tubercles are found in the lungs, an unprejudiced examination of the post-mortem appearances leads to a conclusion Avhich agrees with the prevail- ing views on the relation of pulmonary tuberculosis to pulmonary l)hthisis, namely, that the development of the tubercles has preceded the pneumonic processes, and that the cavities which are found, originate partly in the softening and disintegration of compound tubercles, and have gradually become larger by the softening of fresh tubercles subsequently developed in their walls. In this Ibrm of pulmonary phthisis, which alone ought to be designated as tubercular phthisis, the development of the tubercles seems, as first described by Virchoio, to start, as a rule, in the mucous membrane of the bronchi. In such cases, we frequently find in the trachea and the larger bronchi, granular patches consisting of innumerable miliary tubercles, or ulcers with the characters of the primary and secondary tubercular ulcer, as described by Rokitanshy. Moreover, small whitish and yellow tubercles are found in the smaller bronchi, alongside of the signs of a purulent catarrh; and sections which happen to be made in the right PATHOLOGY. 5 direction show that the growth of tubercles has spread from the bronchus to its lateral and terminal alveoli.* According to the direction of the cut, the compound tubercles formed in this way- appear as roundish or conical agglomerations of miliary granules, an appearance which is rarely or never seen in acute miliary tuberculosis in which the development of the tubercles does not start from the bronchial mucous membrane. The pneumonic processes which complicate tuberculosis in what ice call tiiheoruhr phthisis are, as a rule, much less extensive than in that form of pulmonary consumption which consists alone in chronic pneu- monia, and in that form in which a secondary tuberculosis has complicated the disintegrating and destructive processes only at a period when they were already in an advanced stage. We shall later advert to the circumstance that the greater the con- trast between the high pyrexia, the rapid emaciation and the violent dyspnoea with the small amount of condensation of lung- tissue found on physical examination, the greater is also the danger, the more urgent the suspicion of tubercular phthisis. When the pyrexia, the wasting, the dyspnoea are in a direct ratio to the extension of the consolidated part of the lung, the prognosis is better, because a hope may be entertained that the patient, although affected Avith phthisis, is not suffering from tuhercular phthisis. Having given it as our opinion that many cases of pulmonary phthisis are, during their whole course, caused by inflammatory processes, and that, in the majority of those cases in which tubercles are present in the lungs by the side of j^neumonic pro- ducts, the tubercles have only developed themselves at a later stage of the disease, we now proceed to consider a little more closely the pneumonic processes which lead to pulmonary con- sumption. And, first of all, we must here decidedly oppose the assertion, that a peculiar form of pneumonia, which was from the beginning of a special kind, and must therefore be separated from the other forms of pneumonia, is the foundation of the cheesy infiltrations of the lung, and of their breaking down into cavities. This creation of a " tubercular or cheesy pneumonia" is quite a mis- lake, and threatens us with fresh confusion. On the contrary, * See Luschka, die Anatomic des Menschen, Vol. I. part ii. p. 309. 6 PULMONARY CONSUMPTION. it can be confidently asserted, that every form of pneumonia may, binder certain conditions, terminate in cheesy infiltration, and there is no form of pneumonia of ivhich cheesy degeyieration is the constant and only result. It is true the several forms of pneumonia pre- sent a great variety with regard to the frequency with which the product of inflammation, instead of being liquefied and re- absorbed, becomes more dense and is transformed into a cheesy substance. In common acute pneumonia this termination is rare, in acute catarrhal pneumonia it is rather frequently met with, and in chronic catarrhal pneumonia it forms almost the rule. If we say that common acute pneumonia may also lead to cheesy infiltration of the lung, we must not be suspected to have made a mistake in the diagnosis of the disease. The sudden and violent invasion of the illness, as well as the symptoms and the course of the first stages, especially the character of the pyrexia and the extension of the consolidation, agree, in some cases in which an acute lobar pneumonia leaves cheesy infiltration behind, so completely with the well-kno-svn and strongly marked features of common acute pneumonia that their identity cannot be doubted. Moreover, we sometimes have an opportunity of observing, post- mortem, gradual changes, from the red and gray hepatisation, with well-marked granulation of the surface of a section, to cheesy infiltration. The conditions under which the product of a common pneumonia undergoes cheesy degeneration are not known to us; but we must particularly mention the fact that this termination is not only observed in those persons who have tubercles, old cheesy deposits, or cavities in their lungs, but at least as frequently in previously healthy individuals, and espe- cially in those affected with long-standmg emphysema of the lungs. Tlie termination of an acute catarrhal pneumonia in cheesy in- fi.ltration of the lung-tissue has already been carefully described in a report, by Dr. Meschede* of Virchoiv's Pathological De- monstrations in 1856. More recently Bartels'\ and Ztemssent have in two excellent papers given a clear and complete account of catarrhal pneumonia in all its stages, and have with particular * Wiener Medicinisclie Wochenschrift. 6 Jahrg. 1856. Nos. 24, 25. f Virckoiv's Archiv, Vol. XXI. parts i. and ii. t Pleuritis und Pneumonie im Kiudesalter. Berlin, 1862, p. 293 seq. PATHOLOGY. 7 care described its termination in cheesy infiltration. Acute catarrhal pneumonia originates in a catarrh of the smallest bronchi extending to the alveoli. In this form of pneumonia the lung-tissue becomes consolidated, not by an exudation rich in fibrin, but by the alveoli being filled with young, indifferent round cells. Under the most favourable conditions, this inflam- matory product, abounding in cells, undergoes the same changes which the fibrin and the cells imbedded in it nearly always undergo in common acute pneumonia. The cells become filled with fat-globules and disintegrate, and the contents of the alveoli, having thus become fluid, are reabsorbed, so that air can enter again into the air vesicles. In less favourable cases, the cellular elements accumulate more and more in the alveoli, the fatty metamorphosis which commences in them remains incomplete, the cells lose their round form and, by losing water, shrink into irregularly-shaped corpuscles. To these microscopical changes corresponds the transformation, as presenting itself to the naked eye, of the dull gray, or reddish gray homogeneous consolidation of the lung-tissue, into a dull, yellow cheesy substance. Acute catarrhal pneumonia, which in the beginning is, as a rule, a lobular process, but which may gradually spread over numerous lobuli, and even consohdate an entire lobe, occurs with particular frequency in the course of measles and whooping-cough ; and the numerous deaths which take place in the wake of these diseases, and which until quite recently have been frequently referred to tuberculosis, have their cause for the most part in the fatal ter- mination of a catarrhal 2)neu7nonia arising in the course of the above- named, diseases. But it is also by no means rare that in the course of a primary, genuine bronchial catarrh, the disease extends from the bronchi to the alveoli, and causes a more or less extensive consolidation of the lung-tissue. This form, too, of catarrhal pneumonia may terminate in cheesy metamorphosis, and in a rapid disintegration of the lung-tissue, producing the symptoms of a florid phthisis or galloping consumption, and leading in a short time to a fatal result. Such cases are generally spoken of as instances of " an infiltrated tuberculosis having occurred in the form, or under the mask, of a febrile bronchial catarrh or influenza." This false and confused view of such cases is, at all events, convenient, and shelters the physician against the reproach of having neglected the catarrh until dulness at the apex revealed 8 PULMONARY CONSUMPTION. the seriousness of the case, and, by not taking measures in time, of having allowed it to extend to the lung-tissue. Nor is the termination of acute catarrhal pneumonia in cheesy infiltration exclusively confined to those persons who have already tubercles, cheesy deposits, or cavities in their lungs, but it occurs also in persons whose lungs have previously been quite healthy. There are cases where the conditions under which cheesy degeneration of the product of a catarrhal pneumonia takes place are just as obscure as when an ordinary acute pneumonia takes that termi- nation. "Homines quadrati" are by no means secure against succumbing to an acute catarrhal pneumonia which, originating in a cold, terminates in cheesy infiltration and the destruction of the lung-tissue. In the same manner the strongest and best nourished children may, in the course of measles or whooping- cough, acquire an acute catarrhal pneumonia, which, by its pro- ducts undergoing cheesy metamorphosis, rapidly carries them off. But much more frequently than in persons with a strong consti- tution, and who until then enjoyed sound health, is this termina- tion of acute catarrhal pneumonia met with in weakly and delicate indi^'iduals, who possess but feeble i^owers of resistance against injurious influences, and who, in consequence thereof, easily fall ill and, when ill, but slowly recover. We shall, when speaking of the etiology of phthisis, more fully treat of the causes and symptoms of this vulnerability, which, in popular language, is not inappropriately termed "delicate constitution"; but we will here anticipate that persons with such a delicate and vulner- able constitution, when seized with inflammatory changes of nutrition, as a rule present a striking tendency in the inflamma- tory products to abound in cells — a peculiarity with which the tendency to a cheesy metamorphosis of the inflammatory pro- ducts is most intimately connected. We have said that acute catarrhal pneumonia may lead to cheesy infiltration even in persons whose lungs have previously been healthy : we must add, that individuals who have already suffered from catarrhal pneu- monia, and in whose lungs former attacks have left behind indurations, cheesy deposits, or cavities, are in still greater danger of fresh attacks of acute catarrhal pneumonia taking the same coiu'se. When we come to give an outline of the various forms imder which phthisis generally occurs, we shall also have to mention cases in which the patients are again and PATHOLOGY. 9 again seized by acute catarrhal pneumonia, and in which every fresh attack of this disease leads to an acute extension of the in- durations and destructions of the lung, until the patients at last succumb to a final attack, or die of secondary tuberculosis. Chronic catarfhal jMcnmoJiia is one of the very commonest diseases. It is indeed of this disease that the assertion, so often and so wrongly made, as to the great frequency of '' tubercu- losis," holds good. I consider the term chronic catarrhal pneu- monia suitable to designate those indurations of the lung alone, which have been chiefly described under the name of infiltrated tuberculosis and of gelatinous or tubercular infiltration, and which of late have, no less inappropriately, by some been called tubercular or cheesy pneumonia. These lobular and, when the process is more extensive, not rarely lobar, infiltrations of the lung, in colour and appearance not unlike frogs' spawn, pre- senting on section a homogeneous and smooth surface, not only consist in the filling up of the alveoli with young, indifi^erent round cells, i. e. in anatomical changes which are characteristic of catarrhal pneumonia, but they originate also, with rare ex- ceptions, in the extension to the finest ramifications of the bronchi, and from them to the alveoli themselves, of a chronic bronchial catarrh, famishing a secretion rich in cells. I should certainly not attach any great importance to the designation of this gela- tinous pneumonia, as a chronic catarrhal pneumonia, did I not believe that, by calling a thing by its right name, not only the insight into the etiology and symptomatology of pulmonary phthisis, but also its prophylaxis and treatment, will be advanced. It is not difficult to see why chronic catarrhal pneumonia should, in the great majority of cases, and much more frequently than the acute form of catarrhal pneumonia, and than ordinary acute pneumonia, lead to cheesy infiltration of the lung-tissue. The slow and lingering progress of the disease, which has an ever increasing accumulation of cells in the alveoli as its consequence, perhaps also the aspiration of cellular elements from the smallest bronchi, by which the quantity of cells formed in the alveoli themselves is still further increased, cause, in a purely mechanical manner, the cells thus densely packed together to encroach upon each other, to shrink, and to undergo necrobiosis (Virchoic). There are, however, some few exceptions from the rule that chronic catarrhal pneumonia terminates in cheesy infiltration. 10 PULMONABY CONSUMPTION. If the process ceases before the accumulation, and the pressure on each other, of the cells contained in the alveoli has reached a high degree, they may undergo a complete fatty metamorphosis, and may become liquefied and reabsorbed, so that the air can again enter the alveoli. The fact cannot be denied, that in certain cases more or less extensive consolidations of the lungs of phthisical patients disappear altogether; but this is by no means surprising to any one who has emancipated himself from the prejudices of Laennec's doctrine. — Chronic catarrhal pneu- monia occm's in previously healthy lungs, as w^ell as in those which already contain tubercles, indurations, old cheesy deposits, or cavities. In the former case it mostly forms the first link of the nutritive changes in which pulmonary phthisis consists ; in the other, it contributes essentially to the further extension of the consolidations and destructions in the lungs. Individuals with a strong constitution and sound health possess by no means an immunity against chronic catarrhal pneumonia, but it is in deli- cate, vulnerable persons, more fi'equently than in them, that a chi'onic bronchial catarrh extends into the alveoli. Cheesy infiltration of the lung-tissue, be it caused by the one or by the other form of pneumonia, does not, however, by any means in all, or even in the majority of cases, lead to immediate disintegration of the cheesy injiltrations and to the foi^mation of cavities. On the contrary, these events take place only under certain circumstances, or, perhaps, only in cases of particular in- tensity of the disease. They are evidently brought about, not only by the encroachment upon one another of the cells accumu- lated in the alveoli, but by their exerting also a pressure on the surrounding tissue and its blood-vessels, which causes the walls of the alveoli, thereby deprived of their nutritive fluid, to dege- nerate and to die. Perhaps the anaemia and the necrosis of the lung-tissue are also favoured by the cell development in severe cases not only taking place on the surface, but in the tissue itself. Further on we shall more fully describe the symptoms and the progress of the disease, as it presents itself in those cases in which cheesy infiltration leads to an immediate breaking down of the deposit and to the formation of cavities ; and it will then be shown that the form of disease resulting therefrom corresponds to that of a " phthisis florida" or galloping consumiDtion. If the cell o;rowth is not so abundant as to lead to a consider- PATHOLOGY. 11 able compression of the walls of the alveoli and of their nutritive blood-vessels, the cheesy masses may gradually become still more insj)issated, and the shrunken, atrophied cells may break up into a detritus. The organic substances contained therein disappear more and more, and calcareous salts are deposited, until at last a cretaceous or mortar-like concretion remains. In other cases, on the contrary, the shrunken cells are, in the course of time — then' incomplete fatty metamorphosis becoming at last complete — liquefied and made fit for reabsorption. Whilst one or the other of these further changes occurs in the cellular elements contained in the cheesy infiltrations, an abundant formation of connective tissue takes place in the lung. Tlie cretaceous deposits are encapsulated, and those places from which the cells gradually disappear by liquefaction, through fatty metamorphosis and re- absorption, are filled up by connective tissue. The lung-tissue does not again, in such cases, become permeable for air, but is transformed into a tough, indurated substance. The connective tissue, by its gradual slu'inking, occupying much less space than the sound lung -tissue which it replaces, the lung becomes smaller, the thorax contracted, and, as this contraction has but narrow limits, the bronchi are dilated into oblong and round cavities. This is the most frequent mode of formation of cavities in chronic phthisis. The reabsorption of the cheesy masses, which have subsequently undergone fatty metamorphosis, and have thus become liquefied, may be so complete, that at the autopsy the lung is found quite impermeable for air, riddled by (bronchiectatic) cavities, but without any remnants of cheesy masses. The above description might lead to the conclusion that I do not consider chronic pneumonia and, as pulmonary phthisis is principally caused by clu'onic pneumonia, phthisis itself to be a pai'ticularly dangerous disease ; and, indeed, I do not hesitate to assert that the cln'onic inflammatory processes which lead to consolidation of the lung and to the formation of cavities, usually show a decided tendency to heal, and that under appropriate treatment, persons with extensive consolidations and great cavities in the lungs may often for a long time be kept in a tolerable state, nay, comparatively even in a state of good health. The greatest danger to most phthisical 2yaiients is the develojmient of tubercles. Of course this view, that most phthisical patients have no 12 PULMONARY CONSUMPTION. tubercles in the beginning, but that many of them become tuber- culous in the course of the disease, stands most of all in opposition to the prevailing doctrine ; but I do not doubt that it will gain ground, because it is the only one in accordance with the present state of pathological anatomy, and because it is founded on observations the correctness of which is generally admitted. In fact, it was known to La^nnec that pulmonary phthisis is very commonly complicated with tuberculosis, only his explana- tion of this occurrence was different from ours. Laennec thus sums up the result of his observations : — " II est beaucoup plus commun de trouver une excavatioji et quelques tuhercides anis dejd avarices dans le sommet des poumons, et le reste de ces organes encore crepitant et sains d'ailleurs, farci d'une multitude innombrable de tn's petits tubercules miliaires demi-transparens, et dont presqxie axiom ne prhente encore de 2'>oint jaitne centrale. II est evident que ces tubercules miliaires sont le produit d'une eruption secondaire et fort posterieure a celle qui avait donne lieu aux excavations. Les resultats de I'ouverte des cadavres, compares a ceux de I'observation des malades, m'ont convaincu que ces eruptions secondaires se font a I'epoque o^ les tuber- cules formes les premiers commencent a se ramollir."* Tliese sentences contain, although in other words, still, in fact, exactly the same as we have asserted. The only difference consists in the explanation of that morbid process by which the formation of the softened deposits and of the cavities in the apex of the lung has been brought about. Laennec makes all cheesy deposits and all cavities in the lungs depend upon a preceding tubercu- losis, and it was therefore only consistent for him to declare a fresh eruption of miliary tubercles, which were found by the side of those old morbid changes in the lung, as a secondajy eruption of tubercles. We, on the contrary, are convinced that the cheesy infiltrations and the cavities in the lung are, with rare excei^tions, the products of pneumonic processes, and we must therefore de- signate the supervening development of tubercles as a comjAication. Yet the frequent occurrence of tubercles in lungs which con- tain the remnants of chronic inflammations is in such striking contrast to the rare occurrence of tubercles in lungs which are free from cheesy infiltrations and cavities, that we can hardly * Laennec, traite de I'auscultation mediate. Paris, 1831, tome ii. p. 27 PATHOLOGY. 13 consider that complication as merely accidental, but we are driven to presume some causal connection between the tubercles themselves and those nutritive changes in the lungs which usually precede their development. But all doubt that such a causal connection exists must disappear when the peculiar distribution of tubercles in the lungs of phthisical patients is taken into con- sideration. If there are only few tubercles, they are almost exclusively found in the immediate neighbourhood of cavities or cheesy deposits, and if the tubercles are scattered all over the lungs, we can nevertheless, as a rule, not be mistaken in assum- ing that they have spread from those places, because near them are found the most numerous and apparently oldest tubercles. No doubt, the frequency of this complication, and the de- pendence of the development of tubercles upon the previous changes of nutrition in the lungs, which in most cases is quite unmistakable, has materially heljDcd to support and to confirm Laennecs theory. It was natural from this state of things to draw the conclusion that the inflammatory processes and the new growth, appearing mider the form of miliary tubercles, were to be regarded as difterent stages, or as different degrees of develop- ment of one and the same disease. Even the difference in the anatomical appearance of the two forms of nutritive change was by no means opposed to such a view of the ease. If Ave do not hesitate to refer the syphilitic inflammations and new growths, which are called gummata or tubercular syphilomata, to one and the same constitutional disease, then Ave must not object if the attempt is made to refer the pneumonic changes and the tuber- cular ncAv groAvth Avhich, just as frequently as in the former disease, go side by side, to the common source of some constitu- tional disposition (disposition generale, Laemiec). But there are reasons quite other than the anatomical differ- ence of both processes Avhich in a striking manner refute the correctness of that theory, much as it may appear plausible at first sight. In the first instance, Ave must again repeat that not one single specific form, but that all forms of pneumonia, although Avith different frequency, may lead to cheesy infiltrations and to the formation of cavities in the lungs ; and Ave must add, that in those cases in Avhich this termination takes place, the danger of a complicating tuberculosis is exactly the same, lohether the cheesy 14 PULMONARY CONSUMPTION. products and the cavities he the o'emnants of a cotnmo7i acute or of a catarrhal pneumonia, and whether the latter have come on as an acute disease, or may have gradually been developed. That chronic catarrhal pneumonia — the so-called gelatinous infiltration — leads, more frequently than the other forms of j)neumonia, to tuberculosis, has its cause simply in this, that its products, more frequently than those of a common acute or of an acute catarrhal pneumonia, undergo a cheesy metamorphosis. To this must be added another most remarkable fact, namely, that almost without an exception, when tubercles are formed in a lung which was previously healthy, and free from cheesy de- posits and cavities, cheesy lyroducts, lohich may have originated in the most various morhid processes, are found in other organs. Virchow* who, however, lays much less stress on this cir- cumstance than we do, allows that the question might very well be raised whether there ever occurs an eruption of miliary tubercles without the previous existence of cheesy, or, in La'ennec's meaning, softened primary deposits ; and that the answer to this question must be, that such an occurrence is ex- ceedingly rare, and that, in almost every case, on careful exa- mination there would be found, somewhere or other, an old cheesy deposit. It is only in rare cases that the cheesy degenerations, which are present in other organs, and which are succeeded by an erup- tion of tubercle, are the renmants of tuberculosis, or of a process analogous to that of pneumonia. As a rule, they are either enlarged lymphatic glands which, having been originally swelled by cellular hyperplasia, have afterwards luidergone cheesy de- generation ; or the cheesy remnants of pleuritic, pericardial, or peritonitic effusions ; or the products of chronic inflammations of joints, bones, etc., which have degenerated in the same way. jB?JiZ,f who still uses the old term *' tubercle" for cheesy de- posits, is perfectly right in maintaining that every tissue and every exudation, at a certain stage of its retrograde metamorphosis, mhy he transformed into '^ tubercle.^ ^ Even this comparatively frequent coincidence of an eruption * Virchow, die krankhaften Geschwiilste. Berlin, 1864-66, Bd. ii. p. 724. t Zeitschrift fiir rationelle Medicin von Henleu. Pfenfer. Neue Folge, Bd. xiii. s. 51. PATHOLOGY. 15 of tubercles in the lungs, with the existence of cheesy masses in other organs, can by no means be regarded as accidental. Such an assertion (leaving quite out of the question the gi*eat proba- bility of a causal relation furnished by the reasons given above) would be in striking discord with the results of daily medical experience. Practitioners know very well that even to a pre- viously healthy man a pleuritic effusion which has lasted some time, and has at length become inspissated and cheesy, or a traumatic inflammation of a joint, or any other accidental disease which leaves cheesy products behind, are dangerous enemies, because they are followed in a great number of cases by the de- velopment of tuberculosis of the lungs. Were it not for this ex- perience, the term " tuberculisation," to designate cheesy meta- morphosis of exudations and other morbid products, would certainly have been given up long ago. If, after this explanation, we again repeat that pulmonary tuberculosis follows the pneumonic processes under discussion only in those cases in which they have led to cheesy infiltrations, and that — as was already known to Laennec* — the eruption of tubercles occurs only at the time when the cheesy deposits begin t-r. soften, we can now give it as our opinion that the connec- )n of the tubercles in the lungs with the other changes of nutrition which usually precede them, is by no means a direct and immediate one, consisting in a common origin from one and the same constitutional disorder, but only an indirect one hrouglit ahotit hy the cheesy metamorphosis of the pneumonic pro^ ducts. But we may even give this sentence a more general meaning, and say that tuberculosis is in most cases a secondary disease originating, in some way unhioion to tis, in the action of cheesy m,orhid products on the organism. We jDurposely avoid adding to this view — which, as a matter of course, holds good also for the secondary miliary eruptions caused by cheesy tuher- cular masses — any hypotheses as to the manner in which cheesy metamorphosis, or the presence of cheesy substances, causes the development of tubercles, in order not to weaken the impression of the above statement, which is founded on facts and can hardly be objected to, and which is of great importance, not only for the proper understanding of the etiology and symptomatology, but also for the prophylaxis of tuberculosis. * Compare the last sentence of the above quotation from Laennec. 16 PULMONARY CONSUMPTION. Buhl has decidedly pronounced the constant dependence of mihaiy tubercles on pre-existing cheesy products; but he has gone even fiu'tlier in designating with the same confidence miliary tuberculosis as an infectious disease caused by the recep- tion into the blood of the " tubercular poison," and in comparing it to pygemia, small-pox, etc. I am convinced that this too ex-, elusive view, and the conclusions which this acute observer has drawn from the facts, and which certainly go too far,* ha\e prevented his excellent paper from having that reforming influ- ence on the clinical notions of pulmonary tuberculosis and phthisis Avhich otherwise would certainly not have failed it. Among BuliVs twenty-three cases of miliary tubercles, there are two in which, at the autopsy, no pre-existing cheesy depos'.t and no cavity were found ; and the number of such cases might be considerably increased, although it would always remain small in comparison to the large number of those in which the eruption is undoubtedly of a secondary nature. To assert the constant dependence of tubercles upon cheesy morbid products is one- sided and exaggerated. The assumption of an infection of the blood by the cheesy products has something very enticing in tl e case of acute miliary tuberculosis occurring in most of the organs, and having, indeed, all the appearances of an acute infectious disease, but seems to mc not to apply to a tuberculosis limited to certain parts, and gradually and slowly spreading Avith the symptoms of hectic fever. Nevertheless, I do not consider the objections raised by Virchoiv against BiiliVs theory of infection to be well founded. Even if Buhl were quite right, it is not every cheesy deposit that need of necessity be followed by tuber- culosis, just as it is not every putrid abscess that leads to septi- chasmia. In the same manner may the absorption of cheesy masses, altered by fatty change and liquefaction, or by some other influences, and so losing their infectious jn'operties, become innocuous. Similar occurrences are observed in the case of localised gangrenous and putrid affections. On the other hand, the peculiar mode of extension repeatedly alluded to, and the not infrequent limitation of tubercles to the * Among other things, Buhl says : — " The proposition that miliary tuberculosis is an infectious disease has also its converse meaning, i. e. an infectious disease in an individual who is affected with cheesy deposits or cavities in his lungs is a miliary tuberculosis." I. c. p. 51. f PATHOLOGY. 17 immediate neighbourhood of cheesy products, seem to me to speak much more in favour of a local influence in which, per- haj)S, the Ijonphatics take a jwominent part, than in favour of an infection of the blood. No doubt the fact that the luno-s, more frequently than any other organ, become the seat of tubercles, and that this tuberculosis remains very frequently limited to the lungs, has its cause in this, that the diseases of the lungs, much more easily than those of other organs, leave cheesy products behind them, and that in most, although by no means in all, cases the eruption of tubercles remains confined to certain not very wide limits. The common doctrine, that tuberculosis of the lungs leads very frequently to a secondary tuberculosis of the intestines rests, at least partly, on a wrong interpretation of what is found post- mortem. It is quite true that in a great number of autopsies cavities are found in the lungs and ulcers in the intestines, i. e. a complication of pulmonary with intestinal phthisis. It is also quite common, in those cases in which, besides cavities and cheesy deposits, miliary tubercles are present in the lungs, to find the serous membrane of the intestines, over those places which cor- respond to ulcers beneath it, studded with tubercles, and in these cases we have a complication of piulmonary loith intestinal tuber- culosis. But it by no means follows from this that the intestinal is caused by the pulmonary phthisis, and the intestinal tuberculosis by that of the lungs. On the contrary, the unbiassed examina- tion of the anatomical changes and the consideration of the sym- ptoms which were observed dm'ing life, lead to quite another Conclusion. Although I am so far disinclined to give a too extended meaning to the term " scrofulosis," that, when we come to speak of its etiology, I shall protest against this abuse of the word, still, for certain, and by no means rare, forms of intestinal ulcerations which are classed almost generally with the tubercular ulcers of the intestines, I consider the term ^^ scrofulous ulcers qf the intestine''^ to be the only proper and right one. As " scrofu- lous" are generally designated those ulcers which originate in the inflammation and ulceration of a lymphatic gland which had undergone cell -proliferation, and usually also cheesy trans- formation. They occur, as is well known, most frequently on c 18 PULMONARY CONSUMPTION. the neck, accompanying moist eruptions of the scalp or face, otorrhoea, or diseases of the mucous membrane of the mouth, etc. They are marked by their great obstinacy, by their spreading to the adjacent connective tissue, and by their irregular, indented, and frequently undermined edges. In the same manner the intes- tinal ulcers in question have their origin evidently in the breaking doion of follicles which loere previously enlarged by cell-proliferation and had undergone cheesy transformation. The enlargement of these little lymphatic glands accompanies chronic catarrh of the intestine, in the same manner as the SAvelling of the cervical glands follows an eczematous eruption, etc. No less do the obstinacy, the spreading of the ulceration to the surrounding sub-mucous tissue, as well as the irregular, indented, and under- mined edges, remind one forcibly of the scrofulous ulcers which we have so frequent an opj)ortunity of observing on external parts, especially on the neck. If we add that " intestinal tuber- culosis" is generally considered a disease of particular frequency in childliood, in contrast to pulmonary tuberculosis, and that childhood is also distinguished by scrofulous eruptions, scrofulous catarrhs (as Virchow very appropriately named the catarrhs with considerable swelling and subsequen c cheesy degeneration of the respective lymphatic glands), as well as scrofulous ulcerations ; and if we draw attention to the fact that the ulcerations in ques- tion frequently show the distinct marks of a very ancient origin, viz. that they are often partly cicatrised, that the mesenteric glands contain, as a rule, cretaceous masses or solid earthy con- cretions, then it will be admitted that for such ulcerations the name "tubercular ulcers" is a most inappropriate one, and ought to be replaced by that of " scrofulous ulcers." Even a careful inquiry into the history of the patient leads in some cases to the result at which we arrive by the un^irejudiced consideration of the anatomical changes. It will appear that the patients have already during childhood frequently suffered from diarrhoea and colic, and later from habitual costiveness, interrupted at times by intercurrent diarrhoea. Not unfrequently the development and even the growth of the patient have remained so stunted, that lads of twenty have the appearance of small schoolboys. Of course I do not mean to say that all intestinal ulcerations Avhich are looked upon as secondary tubercular ulcerations are of this scrofulous nature, but I would only caution against con- ETIOLOGY. 19 founding the two forms ; and with this view mainly, I must add that an eriqytion of tubercles of quite recent date is found on the serous membrane^ outside of very old scrofidous ulcers, just as fre- quently as in the hmgs fi'esh miliary tubercles are found by the side of old cavities. This coincidence, namely, the frequent sujjerventioti of a tuber- cidosis of the intestine upon an intestinal phthisis, which cannot be mistaken, if only our eyes are not obscured by prejudices, con- firms to a certain extent the correctness of our opinion that a similar relation exists in the lungs, and that "patients suifering from pulmonary phthisis are in danger of getting tubercles." On the other hand, the correctness, or at all events the universal correctness, of BuhVs theory, according to which miliary tuber- culosis is the consequence of an infection of the blood with the tubercular poison generated in cheesy deposits, is contradicted by those not unfi'equent cases in which tubercles are found on the intestinal serous membrane cxclusivelij in places corresponding to intestinal ulcerations beneath, and in the lungs in the imme- diate neighbourhood of cavities and old cheesy deposits, whilst not a single miliary tubercle can be detected elsewhere. Most of the prevailing opinions on the inherited or acquired disposition to pidmonaru tuberculosis, and especially those bearing on the former, have only a very limited value, because the ob- servations on which they are founded refer by no means to tuber- culosis alone, but also to all those processes which, since Laennec, have been confounded with tuberculosis. The same remark applies to the statistical statements as to the frequent occurrence of tuberculosis in general, its greater or less frequency under the influence of certain conditions, the geographical distribution of the disease, etc. On the other hand, the insight into the causes of pulmonary pihtliisis has been materially aided by the better understanding of the nature of the nutritive changes which constitute it, and especially by the discovery of the dependence of tuberculosis upon those other morbid processes which usually precede it. I do not hesitate to say, in spite of all assertions to the con- trary, that it is by ?w means su^ciently p>roved that tuberculosis, in the strictest sense, is an inheritable disease. Speaking exactly, an inherited tuberculosis can only be assumed where the father or the mother were, at the time of conception, suflPering from true c2 20 PULMONARY CONSUMPTION. tuberculosis, and where the child does not so much get a disease which leads to tuberculosis, but is affected with tuberculosis without any intermediate affection. In infancy, during which tuberculosis of the lungs is rare, there can only be adduced^ as an example of this, in the strictest sense of the word, in- herited tuberculosis, that of the meninges, which is compara- tively frequent at that period of life. This has been done by VircJioiv, among others. But apart from the difficulty of proving that the parents of such children were, at the time of the con- ception, really suffering from tuberculosis, even this miliary meningeal tuberculosis, which nearly always leads to hydrocej)ha- lus, is only in the rarest cases the result of a primary develop- ment of tubercles. I scarcely recollect a case in which, at the autopsy of a child which had died of meningeal tuberculosis and acute hydrocephalus, I did not find cheesy bronchial glands or other cheesy deposits. Buhl declares expressly, that of nine cases of acute hydrocephalus, with miliary tubercles in the jiia mater, the tuberculosis had not in a single one occurred as an isolated affection ; and RoMtanshj* lays it down as a rule, that acute hydrocephalus of children occurs with hypertrophy of the lymphatic glands (scrofulosis), etc. With just as little reason can, as a rule, those cases be adduced as a proof that tuberculosis is inheritable, where grown-up per- sons, even though they are descended fi'om notoriously tubercu- lous parents, have become tuberculous themselves ; for in such cases the tuberculosis is nearly always, in the parents as well as in the child, only the last link in a chain of morbid imtritive changes which have brought about the development of tubercles ; so that it is by no means the tuberculosis itself that has been inherited. Quite as decidedly as we have opposed the evidence that tuber- culosis is inheritable, must we pronounce in favour of a frequent occurrence of an inherited disposition to pidmonary phthisis. But even here what is transmitted is not the disease itself, but a weakness and vulnerability of constitution which in the parents has ah'eady either been the cause of pulmonary phthisis, or has only been developed in them by the disease. The weakness and vulnerability which is transmitted to the children may in the * Lehrbuch der patholog. Anatomie, 3rd ed. Vol. 11. p. 418. -ETIOLOGY. 21 parents depend also upon other causes besides pulmonary phthisis ; and it is therefore commonly said that children born of parents who suffer from syphilis or other exhausting diseases, or who at the time of conception were aged and decrepid, have inherited a disposition to pulmonary consumption. It would be more correct in such cases to speak of a disposition with which the children are born, than of one which has been inherited by them. There are, however, numerous exceptions to the rule that parents who are phthisical or debilitated by diseases or advanced age procreate children with a tendency to consumption. Nor is it at all rare that, under favourable conditions, an innate or inherited tendency to phthisis should disappear. To obtain this end will further on be laid down as one of the most important rules of the prophylaxis of consumption. I shall not be considered an idle and unpractical theoriser in opposing the inheritable disposition to tuberculosis as a thing which is not proved, while I acknowledge the disposition to pulmonary phthisis to be inheritable. I have repeatedly seen that physicians whom I had convinced of the correctness of this view were not only released from an exaggerated and helpless anxiety for the future of their own children who had been born of phthisical mothers, but had also been induced to take energetic measures in order to ward off the threatened danger. The noxious influences by which the tendency to consump- tion is acquired, or the inherited disposition intensified, are sufficiently known, and I shall not therefore enter into their discussion here. Lisufficient and improper food, bad and damp dwellings, want of exercise and of fresh air, and various weaken- ing and exhausting influences, such as venereal excesses, long- continued suckling, depressing mental conditions, etc., are justly considered as such. I will only add a few words on the diseases which dispose to pulmonary phthisis. Among the valuable theses which Avere written under the direc- tion of Dittrich, there are three excellent papers on the complica- tion of pulmonary phthisis (tuberculosis) with diabetes mellitus, with carcinomatous diseases, and with gastric ulcer.* Accord- * Die Harnruhr, von Dr. R. Leupoldt. Erlangen, 1853. Die Combina- tionsverhaltnisse des Krebses und der Tuberculose, vou Dr. C Martius. Erlangen, 1853. Von der Combination der Tuberculose mit dem runden Magengeschwlir, von Z);. B. Papellier. Erlangen, 1861. 22 PULMONARY CONSUMPTION. ing to the statement of his pupils, Diftrich had arrived at the conclusion that the diseases in question, as all other diseases which are followed by tabes, or marasmus prasmaturus, do not rarely lay the foundation of pulmonary phthisis. Although I do not agree with the explanation given by this observer, who, no less distinguished as physician than as patho- logist, was yet completely biassed to the theory of the " erases" (blood-changes) of the Vienna school ; and although we cannot refer tuberculosis to a disease of the blood-fibrin, caused by the injurious influence on the blood of substances formed in an exces- sive retrograde metamorjDhosis, yet we must fully acknowledge the correctness of the observed facts. The injm'ious influence which diseases have on the constitu- tion, and thereby on the tendency to consumption, manifests itself most frequently and in the most lasting manner in earliest infancy. It is fortunate if children escape disease, particularly in the first years of their life, during which by far the most rapid development of the body takes place, and when by favourable or unfavourable external circumstances the foundation is laid, in a great measure, for a strong and robust, or a Aveak and delicate liealth. Even vaccination may, by the febrile disturbance pre- ceding the eruption, as well as by that accompanying the sup- puration, both of which are never absent, and accorduig to my numerous thermometrical observations sometimes reach a very high degree, considerably weaken, more esjiecially those children who are not very strong, and may leave behijid it the germs of a disposition to consumption. This fact is often wrongly inter- preted by uneducated and prejudiced physicians, and has led to the strange theory that scrofulosis and tuberculosis are caused by the vaccine poison continuing to operate in the system. Although this theory is, in my opinion, sheer nonsense, and much as I consider the agitation of those who hold it aoainst vaccination in general as objectionable and mischievous, yet I must protest against unconditional compulsory vaccination, particularly during the first two years of life. At times when there is no epidemic of small-pox, we even expressly forbid the vaccination of weakly and delicate children, and unless there are cases of variola in the place itself, or its neighbourhood, we delay it until the constitu- tion has been strengthened, and until a time when no harm iETIOLOGY. 23 is to be apprehended from the short and, as a rule, inconsider- able illness which follows it. It is evident that all influences by which the inherited as well as the acquired tendency to pulmonary consumption is caused, agree in this, that tliey hinder or disturb the normal development and maintenance of the organism. When this influence operates before the formation of the body is completed, its consequences are visible more or less in the whole habitus of the individual. Although, as a rule, the growth of the body in length has not been retarded, its development in circumference has suffered in comparison. The skin is delicate, the subcutaneous tissue con- tains but little fat, the muscles are badly developed, the long 1)ones are thin, the thorax presents the well-known "paralytic form" which dej^ends upon the insuflicient development of its muscles. Such individuals are generally spoken of as being- predisposed to pulmonary consumption, or, what is the same, as having a "^ jjhthisical habitus.''^ The opposition which has even recently been raised against these terms from many sides, and particularly the objection that not every one with a phthisical habitus becomes consumptive, shows how deeply Laennec's doc- trine has taken root, viz. that tuberculosis, and phthisis with it, are developed quite independently of external causes. From our point of view there is nothing at all strange in the fact that one man with a well-marked disposition to pulmonary consumption remains free from the disease and reaches old age, whilst another who has no such predisposition becomes phthisical by external injurious influences, by an intercurrent illness, etc., and may find an early death. We can only very urgently re- commend that even a trifling bronchial catarrh occurring in an individual with a " phthisical habitus" should be looked upon as a dangerous enemy and treated with the utmost care. Experience shows that delicate and ill-7iourishecl individuals have, as a 7mle, little j^oicer of resistarice against injurious influences^ and that generally they fall ill more easily, and recover from their illnesses slower, than the strong and well-nourished. The frequency, however, with which the several organs of the body become affected varies according to age. Whilst in infancy the membranes of the brain, the larynx, the skin, the intestines, etc., are chiefly liable to disease, the aftections of these organs become -24 PULMONARY CONSUMPTION. less frequent at the time of puberty, and in their stead attacks of bronchial hemorrhage, as Avell as of acute and chronic inflam- mations of the lung, increase in frequency. But the weak and ill-nourished differ from the strong and well-nourished, not only in the possession of this vulnerability, but also because the inflammatonj nutritive changes occurring in them lead, as a rule, to a very abundant 2^^"oduction of indifferent and perishable cells. It is said of such individuals, among other things, that they have a " bad skin for healing," because com- paratively trifling traumatic injuries cause in them a strong irri- tation of the injured parts, leading to an abundant production of pus-cells. This peculiarity seems partly to depend on the fact that an increased irritability is associated with weakness, partly on the fact that inflammatory irritation of badly nourished and imperfectly developed organs leads more frequently to the for- mation of frail and perishable cells than to the formation of those from which young tissue is formed. To sum up the most important points of the preceding dis- cussion, we arrive at the following conclusions : — 1. The consolidations and destructions of the lung which form the anatomical basis of pulmonary phthisis are, as a rule, the products of pneumonic processes ; and the more abundantly cellular elements accumulate in the alveoli, and the longer this accumulation persists, the more readily does a pneumonia lead to phthisis, because the cheesy metamorphosis of inflammatory infiltrations is thereby favoured. 2. Pneumonia resulting in cheesy infiltration occurs chiefly in delicate, badly nourished persons : this experience is partly fomided on the great vulnerability of such persons, and partly on the fact that the inflammatory nutritive changes occurring in them show a tendency to an abundant production of cells, and thereby to a cheesy metamorphosis of the inflammatory products. 3. Pneumonia of this character does not occur usually, even in delicate and vulnerable persons, before the age at which pul- monary diseases generally become more frequent ; and it then takes the place of those inflammatory diseases of other organs which have prevailed dm-ing the preceding period of life. AU the influences, indeed, which disj)ose to pulmonary con- sumption, from the conception by a consumptive father to the ETIOLOGY. 25 exhaustion of the body by a long and serious ilhiess, become perfectly clear and intelligible by these propositions, the correct- ness of which can hardly be doubted. Nor can it appear at all surprising that the disposition to pulmonary consumption will be more or less clearly expressed in the poor and delicate habitus of an individual. We must not omit to add, however, that there are some ex- ceptions to this rule. There are instances of individuals without any signs of weakness or bad nutrition falling ill very frequently and after trifling causes, and recovering but very slowly, whilst others who are apparently delicate and badly nourished possess great power of resistance against injurious influences, whereby they fi'equently escape illness altogether, and if nutritive dis- turbances take place in them at all, they quickly and safely pass off again. On account of these exceptional cases, the actual experience in a person of really existing great vulnerability, is a more reliable indication of his phthisical disposition than his delicate and sickly appearance. A man who in his in- fancy has had attacks of croup or pseudo-croup, and who has afterwards repeatedly suffered from catarrh of the bronchial mucous membrane, from epistaxis or bronchial hasmorrhage, or from pneimionia, etc., is, even with a healthy colour of his cheeks and a robust appearance, in danger of acquiring pul- monary consumption, and must therefore, in apparently trifling catarrhal affections, be watched and treated with greater care than one who has no previous history of that kind. Strictly speaking, we cannot agree with the assertion that the tendency to pulmonary consumption is, as a rule, " combinecV with a general tendency to inflammations, for, according to our opinion, it is based on, or rather is identical with it. In conclusion, we can explain in a few words our position as to the often ventilated question about the relation of scrofulosis to pnlmonari/ consumption. In the increased vulnerability, with which are associated, as a rule, an increased irritability and a tendency of the inflamed tissues to abundant cell-production, the lymphatic glands, espe- cially in childhood, very frequently share. While in individuals who have no such particular disposition the lymphatic glands, which receive their lymph from the inflamed parts, swell, or become inflamed and suppurate, only in the more severe and 26 PULMONARY CONSUMPTION. malignant inflammations, in those who have this tendency, even slight irritation of the glands set up by trifling and benign inflammations about the origin of their lymphatic vessels is sufficient to arouse an abundant production of cells. Inflamma- tion and supjiuration of the glands take place by no means in all, or even in the majorit}^ of cases ; on the contrary, the morbid pro- cess stirred up by the irritation remains, as a rule, limited to a simple cellular hyperjolasia and a swelling of the glands through abundant accumulation of the normal cellular elements. Such glandular swellings, however, show, like all other morbid pro- cesses in such individuals, great obstinacy, and, in numei'ous cases, the more abundant the accumulation of cellular elements, the more readily does a partial or diffuse cheesy degeneration of the swollen glands occur. Individuals whose lymphatic glands thus participate in the general vulnerability and in the disposition of the tissues to abundant cell-growth, when under inflammatory irritation, are called scrofulous. We lay particular stress on the constant combination in scro- fulous individuals of the disposition to swellings of the lymphatic glands by cell-hyperplasia, with a general tendency to illness, and more especially to inflammatory diseases. This latter is, as a rule, so well marked in such cases, that the immediate causes of the ''scrofulous exanthemata," the "scrofulous ophthalmia," and the " scrofulous catarrhs," and other so-called scrofulous affec- tions, easily escape observation. It frequently seems as if those inflammations had appeared spontaneously, or, as the popular saying is, had come on " by themselves." There is no ana- tomical sign by which a " scrofulous skin-eruption," or a " scrofulous oj)htha]mia," could be distinguished from the like affections of a non-scrofulous origin. The dependence of those inflammatory diseases upon trifling causes, their frequent repe- tition and their obstinacy are, besides the. participation of the lymj^hatic glands, the only characters from which their scrofu- lous nature is concluded. If then the slight power of resistance against injurious in- fluences, the "vulnerability" of scrofulous individuals, has not disappeared before the time at which the lungs are chiefly liable to disease, whilst moist eruptions, and obstinate diseases of the cornea or conjunctiva, etc., become less frequent, such I JETIOLOGY. 27 persons are then attacked with pneumonia just as readily, and after just as trifling causes, as they formerly were with eruptions, ophthalmia, etc., and these attacks of pneumonia have the same obstinacy which the so-called scrofulous affections presented ; a circumstance which essentially favours their termination in cheesy infiltration. We have already mentioned that sometimes it happens even in children, although much more rarely than in adults, and more especially in the course of measles and whooping-cough, that a catarrh spreads from the smallest bronchi into the alveoli and leads to pneumonia, which may terminate in cheesy infiltration. Although this occurs chiefly in scrofulous children, still we hesitate to adopt for this kind of pneumonia the term " scrofuloua jvieumonia,^^ because it may easily lead to misunderstandings. On the other hand, wo consider as most practical and acceptable the proposal of Virchow to call a catarrh of the bronchial mucous membrane, which in a scrofulous individual leads to a consider- able and obstinate cellular hyperplasia in the lymphatic glands, in the same manner as a humid eruption on the head causes a similar swelling of the cervical glands, a '■^scrofulous catarrh.''^ If we do not take into account those rare cases in which cheesy bronchial glands, after having softened and broken down, open into a bronchus and lead to a peculiar form of pulmonary phthisis, we can sum iip the relation which, according to our opinion, exists between scrofulosis and pulmonary consumption in the following sentences : — 1. Adults who in their childhood have been scrofulous have, unless the vulnerability on which scrofulosis depends has disap- peared, a well-marked tendency to pneumonia, terminating in cheesy infiltration and pulmonary consumption. 2. In individuals who formerly were scrofulous, persistent cheesy bronchial glands give rise, in some instances, to the de- velopment of tubercles in the lungs and to a tubercular phthisis. 3. Individuals in whom an extinct scrofulosis has not left behind either an increased vulnerability or cheesy masses in the lymphatic glands, possess no greater disposition to pulmonary phthisis than individuals who have never been scrofulous. I consider the almost universal opinion, that pulmonary con- sumption arises independently of accidental or immediate exciting causes, in consequence alone of a " diathesis," to be as unproved 28 PULMONARY CONSUMPTION. as it is dangerous. Evidently the circumstance that it would be in striking opposition to the theory which no one ventured to doubt, to assert that pulmonary consumption could be excited by external causes, prevented an unprejudiced interpretation of the facts. Thus Lehert, among others, says : — " It is important that, as a rule, no particular cause can be detected for the com- mencement of chronic pulmonary tuberculosis, that 'catching cold,' in particular, seems, generally, to be without any direct influence; and this is so true (I) that, provided we are only not satisfied with the vague stories of the patients, but examine carefully and strictly into their previous history, it may be con- cluded that a cough whose significance is not clear does not depend upon tuberculosis whenever it can be made out with cer- tainty that it has commenced with a cold in the head, or angina tonsillaris, in a word, as an acute catarrh of the mucous mem- brane after ' taking cold ' ; and the ^wpular ojnnion that a neglected cold leads to consumption is erroneous."* How can these sentences be reconciled with the experience of any physician in large practice, with the many instances in which the cough, to Avhich the other symptoms of consumption were soon added, began on a certain day, after a distinctly injurious influence ? It is fortunate that the general public ai'e more careful Avith those in whom a disposition to phthisis is suspected than would be necessary if the ideas of the majority of physicians as to the nature of pulmonary consumption were correct. Amone; the immediate causes which can excite the disease in persons in whom a more or less marked tendency to pulmonary phthisis exists must, we believe, be enumerated all influences tvhich are folloiued hy catarrh of the hi'onchi and hy hypercemia of the lungs. We need not further justify this assertion, for its cor- rectness is quite clear to any one who has left the stand -point from which every pulmonary phthisis is considered as a new growth, and who has convinced himself of the fact that in the majority of cases, catarrhal pneumonia is the essence of the disease. We shall further on discuss the measures which are in most cases culpably neglected by those who, when they find a catarrh in the apex of the lung, at once assume it to have originated in, * Lebert, Haudbuch der practischen Medicin, 3rd Edition, Vol. II. p. 130. ETIOLOGY. 29 and to be kept up by, a deposit of tubercle, but Avhich, as a matter of course, will be employed with the greatest strictness by those who fear lest a simple catarrh originating in a " cold'''' may spread to the alveoli, and may thus lead to consumption. The origin of congestion of the lungs in excessive exertions of the body, with accelerated and increased action of the heart, which had long been known, but not sufficiently understood, has, I believe, been brought much nearer to its physiological explana- tion by Dr. Diesterweg'' s* treatise, which contains a series of valuable and striking truths, though, unfortunately, they are not expressed in quite a suitable form. I possess among my reports of cases a number of examples in which excessive dancing, or similar exertions, were immediately followed by the first signs of a commencing pulmonary consumption, without any probability of cold having been taken at the same time. To this class also, perhaps, belong some of the cases in whicli pulmonary con- sumption is said to have been caused by di'inking cold water when the body was overheated by exercise. Besides colds and excessive exertions of the body, dh^ect iirt- iation of the lungs and the bronchial mucous membrane hj fo7'eign bodies plays a most important part among the immediate exciting causes of pulmonary consumption. The frequency of the disease in certain trades can easily be explained from our point of view, whereas it would be unintelligible if in all, or even in the majority of cases of pulmonary consumption, a neoplasm in the lung were the essence of the disease. Anthracosis and siderosis pulmonum (pneumo-koniosis, Zenker) consist, as a rule, in pulmonary phthisis caused by the inhalation of coal- or iron-dust. Among the various foreign bodies which, by direct irritation of the walls of the bronchi and of the parenchyma of the lung, lead to phthisis, the blood ivhich, cfter a hemoptysis or pneumo7'~ rhagia, remains behind and coagulates in the bronchi and alveoli exerts this influence the most frequently. From ffijjpocrates, whose aphorism, "'EttI at/xaTc; e/xerq) (jfjSo?; Kal rod irvov KdTapcnercidosis of the bronchial mucous membrane and of the alveoli ; and we can confirm every word of Canstatfs, " that it is a very critical symptom, and one which strongly arouses the suspicion of a tuberculosis, when obstinate cough and pyrexia are accompanied by sputa which for a long time keep the crude character, like those of acute bronchitis, "t The other peculiarities of cough and expectoration which are mentioned by the authors as being characteristic of tuberculosis, * Crachats stries de lignes jauiies of Louis. t Canstatfs specielle Pathologie und Thei-apie, dritte giinzlich uragear- beitete Auflage von Dr. Henoch. Erlangen, 1855, B. ii. p. 662. SYMPTOMS. 47 arc to us signs of phthisis, but by no means signs of the former. The "sputa globosa fundum petentia" point to nothing but a roundish cavity ; the small rice-like bodies in the sputa, if not coming from the tonsils, are due to a diphtheritic destruction in the wall of a bronchus or of a cavity ; the sinking of the sputa in water shows that they do not come from the larger bronchi, where a greater quantity of air is generally mixed with them ; the discovery of elastic fibres in the sputa is a certain sign of a destructive process, etc. For tuberculosis we must look out for other signs. Nay, Ave may even confidently assert that a patient wlio^ besides other signs of pulmonary consumption, brings up sputa from loliicli ice can conclude an extensive destruction of the lung^ is frequently hi less danger than a patient ivho is feverish and becomes pale and thin, and only eapectorates viscous and transparent sputa. Not unfrequently we succeed in prolonging life, in im- proving the strength, and in increasing by many pounds the weight of patients who have expectorated masses of elastic fibres and are emaciated to the utmost, if only they are under favour- able circumstances. My reports of cases contain numerous proofs of the correctness of this assertion. A hoarse or aphonic cough is one of the most important signs of tubercular phthisis, or I'ather of the complication of a pldliisis lohich originally consisted in destructive inflammatoi'y processes toith tuberculosis. Those very interesting cases in which, in phthisical patients, the alteration of the voice and of the tone of cough is due to a paralysis of the vocal chords caused by pressure of thickened pleura on the recurrent nerve, are so rare that they may almost be neglected, in comparison with those cases in which tubercular ulcers of the mucous membrane ai*e the cause of the symptoms alluded to. If the cough becomes rough and devoid of tone onh^ at an advanced stage of consumption, this may be taken as a sign of secondary tuberculosis ; if, on the contrary, it presents this character from the beginning, and especially at a time at which the sputa are still viscid and transparent, and at which the phy- sical examination of the chest does not reveal any well-marked disease, then a primary tubercular phthisis may be suspected. Not rarely, as we have mentioned before, does the development of miliary tubercles begin in the trachea and in the larynx, spreading only at a later period to the smaller bronchi. 48 PULMONARY CONSUMrTION. Pyrexia is one of the most constant symptoms of a chronic pneumonia as well as of a tuberculosis. Ziemssen has shown that in children the extension of the catarrh to the alveoli is always accompanied by a considerable increase of the temperature and of the fi'equency of the pulse. This is no less true of the commencement of catarrhal pneumonia in adults. The statement of Louis, that in the majority (four- fifths) of patients, pyrexia comes on only at a more or less advanced stage of tuberculosis, is explained by the fact that this observer takes his stand-point on Laennecs theory, and therefore refers the prodromal catarrh to an already existing tuberculosis. We have repeatedly drawn attention to the dangerous conse- quences of this error, and we believe we can 'confidently say that by accurate observation of the temperature and pulse in every simple catarrh, and by the most cai'eful treatment of every case in which pyrexia comes on in the course of a protracted catarrh, the development and progress of phthisis can very frequently be prevented. Just as the occurrence of pyrexia is an important symptom of the extension of a catarrh from the bronchi to the alveoli, so its continuance furnishes the most important proof that the pneu- monic processes have not yet terminated. The cm'ves, which can be constructed by graphically representing the morning and even- ing temperatures of phthisical patients, show usually a striking resemblance to each other, and it is possible to conclude from them a pulmonary phthisis almost with the same certainty as we can do in the case of typhoid fever or of acute pneumonia. The difference of morning and evening temperature amounts, as a rule, to 1° to 1-5^ C. (1-8° to 3-6° F.) ; it is rarely less, very often considerably greater; frequently the temperature is found in the morning nearly normal, whilst in the afternoon or evening it rises to 39° C. (102-2° F.), or even higher. TJiis course of the temperature is not, however, as might be su2:)posed, peculiar to all consumptive fevers. If we compare the tempera- ture-curve of a phthisical jiatient with that of another who is suffering from a protracted superficial suppuration, caries, etc., we find a great difference, especially wdth regard to the regularity of the mornino; remissions and of the evening; exacerbations. We have not yet arrived at definite conclusions in our investigation of the hectic fever of phthisical patients, especially concerning SYMPTOMS. 49 the causes by which its regular course is disturbed ; but wo can ah'oady say this much, that in tubercular j^htldsis in the restricted sense, and when tuberculosis comjylicates a destructive 2'>newnonia., the differences between morning and evening temperature are, as a rule, much smaller. We therefore give, cceteris paribus, a more favourable prognosis as long as the pyrexia has the characters of a ^' febris remittens," with almost intermittent type, than when it approaches to that of a " febris continua." In the former case, we have in numerous instances been successful in moderating, or altogether removing, the fever, and, as a consequence thereof, in considerably improving the strength and nutrition of the patient, whilst in those in whom the pyrexia did not present any morning remissions we cannot boast of any similar results. When the cheesy masses are encapsulated, or have afterwards become fluid and reabsorbed, the pyrexia may disappear alto- gether ; and it frequently happens that patients with considerable cavities in the apices of their lungs are perfectly free from fever. In the cases in which the pneumonia has terminated in indura- tion, the physical signs, and the globular sputa which are expectorated day after day, especially in the morning, are in striking contrast with the subjective feeling of comfort of the patient, his fresh and healthy appearance, and the state of his strength and nutrition. We have explained sufficiently that such persons, although their present illness may have terminated in a relative recovery, are nevertheless in danger of dying from consumption by a relapse of pneumonic processes, or by subse- quent tuberculosis ; and we must recommend as a good practice a frequent examination of their weight, and occasionally of their temperature, in order to find out if any of those eventualities may not possibly have occurred. From these remarks it is evident that the use of the thermo- meter is at least of as great, if not of even greater, importance for the diagnosis, prognosis and treatment of pulmonary phthisis than of any other disease. The impoverisliment of the blood and the emaciation, symptoms to which phthisis owes its name, are placed by us after the pyrexia, because we have no doubt that the pyrexia is their principal cause. Among the proofs for the correctness of the theory that the febrile increase of the heat of the body is due to an increased production of heat, the rapid decrease of the weight E 50 PULMONARY CONSUMPTION. of the body, under the influence of a fever of even short diu'ation, is one of the most striking. It is especially in patients with phthisis that it has for 3^ears back, in my wards, been made out by numberless examinations with the thermometer and the weighing- machine, that the decrease and increase of the weight of the body are respectively in relation to the height of the fever, or to its disappearance.* There is great plausibility in the supposition that a continuous pyrexia of moderate intensity, especially if the patient keeps in bed, causes less waste than one in which, as in the hectic fever of phthisical patients, the temperature rises daily from a nearly normal temperature to a considerable height. But, though the heat-production and tissue-waste are, as shown by Immermann,'\ very considerable during the rapid rise of tem- peratiu'e, we still hesitate to assume the correctness of that hypothesis. The knowledge that in phthisical patients the strength and the substance of the body are principally consumed by the fever is of the greatest importance for the treatment of pulmonary consumption. The pliysical signs which hitherto have been considered charac- teristic of " pulmonary tuberculosis " gain a different meaning for those who have left Laennec^s stand-point, and thudv it neces- sary, in every case, to make out Avhether there is present a tuber- culosis, or the disintegration of cheesy infiltrations or inflamma- tory processes which have led to destruction and shrinkhig of the lung-tissue. Although the two processes are frequently combined, still it can by no means be asserted that this is always the case ; and even where such a combination exists, it is of importance to find out whether one or the other form of nutriti^^e change prevails. For this reason, we shall attempt to submit the physical diagnosis of pulmonary phthisis to a short critical consideration from our point of view. We know that a man with a jMrcdi/tic thorax and a phthisical appearance may have perfectly sound lungs ; but, as we have * Compare the publications by Liebermeister in the " Prager Viertel- jahrsschiift," Vols. LXXXV. and LXXXVI. and in the "Deutsches Archiv fur Klinische Mediciu," Vol. I. t De morbis febrilibus qusestiones nonuullse. Inaugural Dissertation. Berlin, 1860. SYMPTOMS. 51 already fully discussed, wo presume in him a certain feebleness or vulnerability, in connection with which, catarrhal and other affections easily become protracted and leave cheesy products behind. It is obvious that this circumstance may, in a given case, be of some weight in arriving at a diagnosis. As, how- ever, the disjDosition to affections with cheesy products includes, to a certain extent, the disposition to tuberculosis, we must, in a patient with a paralytic thorax, especially if an old consolidation can be detected in one or the other apex, consider, cceteris parihus-^ the chance of a tuberculosis having been developed as more pro- bable than in one who does not present those symptoms. It is generally admitted that the physical signs in the " first stage of pulmonary phthisis" depend only upon the catarrhal swelling of the bronchial mucous membrane, and on the presence of a secretion in the bronchial tubes. According to the prevail- ing opinion, " as long as the only physical signs ai'e increased or diminished vesicular breathing, interrupted respiratory murmur, prolonged expiration, or rhonchi and rales in the apices, the tubercles, or aggregations of tubercles, have not yet coalesced to extensive peripherally - situated consolidations." But "as a catarrh lohich is conjined to the apices always (!) depends upon the irritation which tubercles produce in the surrounding parts, it is a certain sign of a commencing puhnonarij tuherculosisJ''' This assertion stands in direct opposition to the results of patholo- gical investigation. In the apices of the lungs, pneumonic pro- cesses of old or recent date, induration and shrinking of the lung-tissue, cavities formed by bronchiectasis, or by the breaking down of cheesy infiltrations, are found much more frequently post-mortem than tubercles. We must not, however, overlook the fact that catarrh of the apices has a peculiar tendency to attack the walls of tlie bronchi and their lateral and terminal alveoli. As long as the peribronchitic and pneumonic deposits thus oriffinatino; have not been massed together into extensive consolidations, dulness and bronchial breathing must evidently be al)sent, and, the symptoms of catarrh excepted, physical examination yields only negative results. Even from our point of view, therefore, a protracted catarrh in the apex of a lung must be considered a grave symptom. The longer it persists, the more ground is there to fear that it will lead, or has already led, to those nutritive changes which most frequently constitute £2 52 PULMOXARY COXSUMPTION. pulraonaiy phthisis. That the catarrhal inflamniation has really attacked the walls of the bronchi and the pulnionaiy tissue can, from what we have previously said, be concluded chiefly from the appearance of pyrexia, the impairment of the general healtli, the loss of flesh, and the pallor of the skin. But even in such cases we have, after careful treatment, so frequently seen a perfect recovery, that we cannot consider the termination of pneumonic processes in cheesy infiltration and destruction of lung-tissue, i. e. in phthisis, as the only possible one. We there- fore consider the catarrh of the apex neither as a certain sign of a commencing i)ulmonary tuberculosis, nor as a constant fore- runner of pulmonary ^>/tf/a'*«Sj but still as a sign that the 2Mtie7it is in danger of hecoming consumi^tive. JDuIness on percussion, bronchial breatliing and consonaitt rales in the upper parts of the thorax are, even by the public, held to be pathognomonic of pulmonary tuberculosis or phthisis. The majority of patients, on consulting a new physician, can exactly describe how far the dulness extended at the last examination. As dulness on percussion, or bronchial breatliing, are pi'obably never caused by the aggregation of single tubercles or of masses of tubercles only, Ave may with certainty from those signs con- clude the existence of pneumonic processes or their remnants. We do not by any means deny that a patient with dulness and bronchial breathing in the apices of his lungs may not also have tubercles. On the contrary, we shall by-and-by refer to the symptoms from which we may conclude the presence of tubercles in addition to the remnants of inflammatory changes in the lungs ; but as a general rule the following holds good : — If the extension of the dulness and of the bronchial breathing stands in a direct ratio to the progress of the general symptoms of phthisis, the prognosis can be pronounced comparatively more favourable than in those cases in which a patient rapidly ema- ciates with violent pyrexia, the extension of dulness not being in proportion to the progress of the other symptoms of the disease. In the former case we have principally to deal with jjueu- monic processes, in the latter probably with a new growth (tubercle). A percussion sound which is not exactly dull, but which, besides being not so full, is somewhat tympanitic * is one of the * The Germau medical schools, foUowing Skoda, employ the term " tym- SYMPTOMS. 53 symptoms whicli, in a patient with higli frequency of respiration, with cough and scanty exjoeetoration, etc., must raise suspicions that, by the presence of tubercles, the quantity of air contained in the lung is diminished and the lung-tissue relaxed. Not long- ago a patient (Krauss) was admitted into the Hospital Avith serious brain-symptoms, in whom the slightly tympanitic per- cussion-sound, the diminished extent of the respiratory movements of the chest, and the diminished respiratory murmur on the left half of the thorax, were essential symptoms in aid of the diagnosis of tubercular meningitis, to arrive at which was in this case particularly difficnlt. We concluded, from the symptoms alluded to, that, most probably, there existed an extensive eruption of miliary tubercles in the right lung, and thereby we gained an important guide for the interpretation of the cerebral disease, the correctness of which was afterwards confirmed by the antopsy. "We must not, however, omit to add that the percussion-noto may assume the same tympanitic character from the prcsenco of small pneumonic deposits. ll\\e flattening of the supra- and infra-elavlcidav regions on one or both sides, which hitherto has played such an important part among the symptoms attributed to pulmonary tuberculosis, as Avell as the loicer situation of the upper edge of the lung (^Seitz), are signs neither of a tuberculosis, nor of a cheesy infiltration, nor of a destruction of lung-tissue, but ahmys and alone of a diminu- tion in size of the apex of the lung by indnration and shrinking. It is true, the same process which has caused the flattening of the thorax may have led, at the same time, to the formation of cavities by bronchial dilatation, the walls of which may be the seat of a diphtheritic destruction ; nor is it improbable that in other places in the lungs cheesy deposits are disintegrating, or that the pulmonary tissue may be stndded witli tubercles ; but it is to the general state of health, to the sputa, or to other physical jKinitic" ioT that quality of percussion-sound which, by its more musica character, admits of distinguishing its pitch, such as the sound produced on percussing a healthy lung, taken out of the thorax, when its tissue, being no longer expanded beyond the equilibrium of its elasticity, collapses to a certain extent ; or when, by some cause or other, the lung-tissue can partly collapse within the thoi-ax, or when it loses its elasticity altogether, i. e. becomes relaxed. It corresponds to the terms " tubular" or " amphoric" of English observers. — C. B. 54 PULirOXARY CONSUMPTION. signs that we must look for support in the diagnosis of the one or the other of these nutritive changes, before we can pronounce a patient with flattened supra- or infra-clavicular regions to be suffering from phthisis. When such support is wanting, then the symptom under discussion becomes even an important sign for one of the most favourable terminations, namely, for the com- parative cure of that process to which phthisis is mostly due. Certainly such patients do not, for that reason, possess any immunity against phthisis ; on the contrary, as is sufficiently evident from what we have said, even if they are not con- sumptive at the time, they are in much greater danger of becoming so by fresh pneumonic attacks, or by a subsequent tuberculosis, than persons without indurations and shrinking of the apices of their lungs. The diminution of the respiixitori/ movement in the upper part of the thorax has, if concomitant with flattening of the corre- sponding area, the same significance that Ave have attributed to the latter symptom. In such cases the shrunken lung-tissue, which has become impermeable to air, cannot follow the traction of the inspiratory muscles, and the area which remains uncx- panded on inspiration retains its usual shape : but if the per- cussion-note over it be dull, we may conclude an cxtensiA'c consolidation of the lung-tissue, and most likely a pneumonic infiltration. Diminished respiratory movements in a place in which, on percussion, there is no dulness, but a normal, or a somewhat altered and tympanitic resonance, create a suspicion of tubercle ; but they arc no certain sign of their presence, since small, discrete, lobular, 2:»neumonic infiltrations may also, without producing dulness, cause a like diminution of the respiratory movements. Lastly, the cavernous sounds, including the " metamorphous respiration"* {Seitz), which is tolerably frequent, are not likely to occur with "tubercular" cavities. I consider it altogether * Under the name " Metaraorphosirendes Athmen," Pi-ofessor S'eitz has described a peculiar variety of respiratory murmur which he considers as a certain sign of a cavity. It occurs principally with the inspiration, and consists in a respiratory murmur which suddenly changes its original cha- racter. Thus a very sharp respiratory sovmd, almost resembling a stridor, .SYM^To:^[s. 5S doubtful whether extensive cavities are ever formed by aggregated tubercles softeuiug, becoming fluid, and being expectorated, or that they become larger by the same j^rocess repeating itself over and over again in fresh tu])erclcs deposited in the walls of the primary cavity. There is no doubt that most of the larger cavities in phthisical lungs are partly of bronchiectatic origin, and partly formed by the breaking down of cheesy infiltrations. The well-laiown and much-dreaded set of symptoms, which is con- sidered to be pathognomonic of bronchiectatic cavities, holds good only in the lower lobes of the lung, because their contents are expectorated with greater difficulty, and therefore easily undergo putrefaction. In bronchiectatic cavities in the ajoices of the lungs, which are much more common than those in the lower lobes, putrefaction takes place but rarely, as their contents are much more easily expectorated. When without any flattening of the supra- or infra-clavicular regions, or any abnormal lowering of the upper margin of the lung, cavernous sounds are heard in the apex, we may conclude Avith probability that the cavities have their origin in destruc- tion of lung-tissue. When, on the contrary, besides cavernous sounds, the signs of induration and shrinking of the apices just mentioned are present, it may be assumed that the cavities are of bronchiectatic origin. It is of by no means rare occurrence for individuals with the last-named symptoms to enjoy for a long time comparatively good health, to retain their whole strength, and rather gain than lose weight, until they are seized by a fresh pneumonic attack, or by a secondary tuberculosis, to which they succiunb. In conclusion, I shall attempt to di'aw a picture of the most important features of the dift'erent forms in which pulmonary consumption usually occurs ; and first we shall occupy ourselves with that form in which the symptoms are brought about alone by pneumonic 'processes and their termination. This form does not infrequently begin with more or less violent symptoms, exactly like an acute disease. It includes suddenly assumes a soft, blowing character, and this lasts until the end of the inspiration. Di'. E. JSeitz, die Auscultation u. Percussion der Respira- tions-organe. Erlangen, 18G0, p. 138. Dr. E. Seitz, iiber ein neues Hohlenger'ausch. Deutches Archiv fiir Klinische Mediciu, Vol. I., 18G5, p. 292.— C. B. 56 PULMONARY CONSUMPTION. those cases In which a common acute pneumonia, instead of terminating in resohition, leads to cheesy infiltration and to .phthisis; those in which intense and wide-spread pneumonic processes have been set up by the blood which, during an attack of haemoptysis, filled the bronchi and alveoli, and coagulated in them ; and lastly, those in which an acute bronchial catarrh extends to the alveoli of larger portions of the lung. The termination of acute })neumonia in cheesy infiltration and phthisis — Avhich, however, is of rare occurrence — must be apprehended if the pyrexia does not cease at the end of the first or in the beginning of the second week of the illness ; if in the evening hours the fever rises considerably, a remission, accom- panied by profuse perspiration, taking place towards morning; if the dulness over the chest persists ; if within the area of that dulness moist crepitant rales are heard for some time ; and if larger quantities of purulent sputa are expectorated. The dis- covery of elastic fibres in the sputa, and the existence of cavernous sounds, leave no doubt that the cheesy tissue is breaking down. The majority of patients die after a few weeks, consumed by the violent fever. Much more rarely a favourable turn takes place at a time when the worst fears have already been enter- tained : the expectoration diminishes, the patients commence slowly to gain strength, but the dulness persists, the chest gradually flattens in the corresponding area, and, after some time, distinct signs of induration and shrinking of the diseased part of the lung, and frequently also of bronchiectatic cavities in it, reveal themselves. A very similar course is taken by some of those pneumonic processes which immediately follow an attack of haemoptysis or pneumorrhagia, and which, according to our view, are caused by the blood which has been poured into, and has coagulated in, the bronchi and alveoli. The more extensive the dulness which is developed in the course of a ha?moptysis, the longer it persists, and the more pronounced the pleuritic symptoms, the more violent the pyrexia, and the longer it continues, the more reason is there to fear that the retained blood and the inflamed lung-tissue have undergone a cheesy metamorphosis, and that extensive destruction of the lungs is imminent. But that, even in such cases, the cheesy masses may in course of time become fluid and be reabsorbed or encapsulated, and that by an abundant growth SYMPTOMS. 57 of connective tissue, induration and shrinking of the diseased part of tlie hing may be induced, is proved by the examples related above. The spreading of an acute catarrh to numerous alveoli is also sometimes accompanied by very serious symptoms, especially by such intense pyrexia and so rapid a loss of strength and flesh that the diagnosis may at first be diflicult. It is pardonable in such cases, for a time, and until the case becomes clearer, to con- sider the catarrh and the violent fever as the consequence of some infection, or of an acute development of tubercles in the lungs. But usually the case soon becomes clearer. Some sputa show, by intimate admixture of blood, the pathognomonic colouring of pneumonic sputa ; more or loss violent or extended pleuritic pains arise ; the percussion-note in the upper parts of the chest loses its full quality and becomes tympanitic, and even dull, when the originally lobular foci coalesce into extensive consolidations ; under the same conditions the rales, Avhich formerly had no definite character, become consonant, the respiratory murmur bronchial, etc. It sometimes happens that these catarrhal infiltrations of an acute origin become completely resolved ; but much more fre- quently the infiltrated tissue undergoes cheesy metamorphosis, and in a short time disintegrates. The majority of cases of gal- loping consumption, in which extensive destruction of the luno\s takes place within a few weeks, and where the patients rapidly emaciate and die under the most intense pyrexia, originate in the spreading of an acute catarrh to the alveoli of larger portions of the lungs, and may be designated as the termination of an acute, or sub-acute, catarrhal pneumonia in " phthisis florida." If the process under discussion extends over an entire lobe, a gradual reabsorption, or a sequestration of the cheesy masses, and indu- ration and shrinking of the diseased parts, rarely takes place ; yet we have had for years an opportunity of observing, in the Hospital, a striking example of this course of the disease in a sword-cutler named Schmidt, 24 years of age. In this man the whole upper lobe of the left lung is considerably contracted, the heart lies in a large area immediately behind the chest-walls, its apex is displaced to the left, the right lung is the seat of con- siderable compensating emphysema, and reaches two fino-er- breadths lieyond the left margin of the sternum. 58 PULMONARY CONSUMPTION. When the acute catarrhal pneumonia leaves cheesy infiltra- tions of inconsiderable extent, the termination in induration and shrinking is much more frequent. The sinking-in of the supra- and infra-clavicular regions, and the lower situation of the upper margins of tlie lungs, can in many individuals be referred to an attack of acute catarrhal pneumonia, which became protracted, and terminated in the manner just described. Not infi'equcntly even we have an opportunity of observing patients who, having, after shorter or longer intervals, been seized again and again by such attacks, get safely through them, but in whom, after an attack, an extension of the dulness, and of the area within which the chest is flattened, remains behind, until at last they are carried away by a pneumonic process which takes a less favourable turn, or by tuberculosis. In contrast to the cases hitherto considered, the extension of a catarrh from the bronchi to the alveoli may take place without any serious symptoms, and even in quite a latent manner. We very frequently find in the apices of the lungs contracted cica- trices, encapsulated cheesy deposits, callous indurations, as rem- nants of pneumonic processes which entirely escaped observation. In the same manner we get in many persons a flattening of the supra- or infi-a-clavicular region, and an abnormal lowness of the upper margin of the lung as notable by percussion, without being able to make out at what time and with what symptoms the pneumonia occurred which has led to induration and shrinking of the apex of the lung. But whenever the process becomes at all extensive, even clironic catarrhal pneumonia seems always to be accompanied by pyrexia. This lingering fever is, however, as a rule, overlooked or mistaken by the patients, and sometimes also for a time by the physician. For the more palpable subjective febrile sym- ptoms, such as shivering, a feeling of heat, increased thirst, etc., are in such cases insignificant, and are obscured by the results of the increased waste of tissues, and of the injurious influence which the pyrexia has on the appetite, the digestion, blood-formation, and nutrition. When a patient with a chronic bronchial catarrh, by which hitherto his general health and his strength have not been im- paired, loses his appetite, becomes pale and thin, and notices a SYMPTOMS. 59 diminution of his strength, there is reason to suspect that the disease has spread to the alveoli, and it is urgently desirable to make out, by accurate observations of the temperature of the body, and by repeated physical examination of the chest, whether there be any pyrexia, or whether consolidation can be detected in the lungs. The chronic form of catarrhal pneumonia shows a marked tendency, under favourable external circumstances, to terminate in induration and contraction, but no less, under the influence of injurious conditions, to frequent relapses. This is the explanation of the fact that numerous patients, although they have extensive callous indurations and brochiectatic cavities in the apices of their lungs, enjo}' tolerable health, and gain strength and weight during the summer months, but in winter, especially if they be obliged to work, and to expose themselves to catching cold, become feverish, weak, thin and pale, and acquire fresh consoli- dations in their lungs. This change repeats itself in many cases for several years. Such patients form a large contingent to the hospitals, where, unless they present particularly rare physical signs, they are mostly unwelcome guests, since " chronic pul- monary tuberculosis " (!) is generally considered to be a disease of but little interest. The great influence which therapeutic, especially hygienic, measures have, particularly on this, by far the most frequent form of phthisis, is, from our stand-point, thoroughly intelligible, and is, as it were, a proof of the correct- ness of our views. The possibility that, in tlie course of a lyuhnonary 2^hthisis caused hi/ pneumonic j^i'ocesses, a tuherculosis may he develojyecl, must be constantly kept in view. We may here recall the statement which we have made above, " that the greatest danger to most phthisical patients is the development of tubercles." This may occur at any stage ; and even when a pulmonary phthisis takes the most favourable course, we must not be too confident and give, unconditionally, a good prognosis. The development of tubercles in phthisical lungs may take place in so latent a manner that it cannot be diagnosed, or, at all events, not with absolute certainty. In many other eases, on the contrary, especially in those in Avhich the lungs become the seat of very numerous tubercles, and in which the tuberculosis extends to other organs also, the diagnosis does not present any difficulty. When we find a patient who is suffering 60 PULMONARY CONSUMPTION. from pulmonary phthisis becoming very short of breatli, without any extension of the dulness over liis thorax ; Avhen the pyrexia continues, in spite of the most careful treatment, and when the remittent fever becomes a continuous one ; wlien diarrhoea takes the place of a tendency to constipation which may have existed before ; when to the other symptoms hoarseness or aphonia, or the well-known signs of an affection of the membranes at the base of the brain, supervene, then we may assume with perfect confidence that in the case before us a tuberculosis has associated itself with the phthisis. Tlie cerebral symptoms in the young, in whom tuberculosis has a special tendency to attack the mem- branes of the brain, and in older persons the symptoms on the part of the intestines and the larynx, furnish the chief points for the diagnosis. That form, lastly, under "which a primmy tuhercuhw p/(f7;?s?'5 commences and takes its course, is essentially different from those hitherto considered, and is mostly so characteristic that the dia- gnosis of this not very frequent form of phthisis is, as a rule, easy. In the first place the prodromal catarrh is absent. The pyrexia and the " consumption" do not begin only at the time when the patients expectorate profuse muco-purulent sputa, but, on the contrary, the eruption of tubercles, especially if very intense, occurs with a considerable elevation of temperature, and with a rapid consumption of the body by the high pyrexia. If we hear from a patient that he has only commenced to cough and to expectorate, after having for weeks past rapidly become feeble, pale and thin, we must suspect him to suffer from a tubercular phthisis. Tliis suspicion gains further ground if the patient is unusually short-breathed, and if the physical examina- tion of the chest yields at first negative results. Later on the per- cussion-sound may, by subsequent pneumonic processes, become dull, the respiratory murmur bronchial, the rales consonant, but in some cases only do the infiltrations of the lungs become so extensive as in those forms of pulmonary phthisis previously con- sidered. At an early period the tone of the voice and of the cough generally becomes hoarse, and when the tubercular affec- tion of the larynx is considerable and spreads rapidly, the well- known painful symptoms of laryngeal phthisis come on. The signs of intestinal tuberculosis, and of intestinal tubercular phthisis, are not, as a rule, long in making their appearance. SYMPTOMS. 61 The consumption is increased by abundant diarrhoea, the abdo- men becomes tender on pressure, etc. The disease rarely lasts more than a few months. Most of the patients succumb even at an earlier period. It has not been my intention to give an exhaustive descrip- tion of the course of the preceding forms of pulmonary phthisis, or to allude to the innumerable modifications which have their origin in individual peculiarities, in the frequent changes of acute and chronic processes, in the various intercurrent affections and complications, and in other circumstances. Nevertheless, it will not be difficult to range under one or other of the forms specified most of the cases of pulmonary phthisis which we ob- serve, or of which Ave read good and complete descriptions. TREATMENT OF PULMONAEY CONSUMPTION. The treatment of pulmonaiy phthisis has gained much firmer ground by the just appreciation of the fact tliat this disease consists, as a rule, in pneumonic processes, and in some cases only in a new grov.th (tubercle). Although we do not owe to this knowledge the introduction of new remedies "which arc a certain cure for ])hthisis," yet we have been enabled by it to establish more exact indications for those in general vise, and to obtain in many cases, by their consistent employment, better results than were obtained at a time when pulmonary consumption was considered as incurable as a carcinomatous disease, and was treated accordingly.* In order to iirevent pulmonary consumption, we have first of all the duty of placing, if possible, those in whom we observe signs of a weak constitution, especially if there exist already proofs of a great vulnerability and a tendency to diseases Avitli the formation of cheesy products, under such influences as we hope may strengthen their constitution and extinguish that mor* bid tendency. Without entering into a full discussion of the dietetic measures which are indicated under such circumstances, I will only call attention to a very common and palpable error. Cautious mothers, especially those who have already lost children from croup, capillary bronchitis, etc., and who, from the repeated illness of their remaining children, are anxious about them, are in the * With regard to the curability also of phthisis, even to this day most physicians hold Laennecs views : — " Presque tous les hommes de I'art, qui sout au couraut des progres recens de I'anatoraie pathologique, peasent au coutraire aujourd'hui que raflfection tuberculeuse est, comme les affections canccreuses, absolument incm-able parceque la nature ne fait que des efforts contraires a la guerison et que Vart n\n peutfaire que d'inutiles. Laennec, I. c. ii. 58). TREATMENT. 63 liabit, in order to save them from colds, of restricting the enjoy- ment of the open air to a most injurious degree — and this is often done with the concurrence even of their physicians. Although the injurious influence which continuous indoor life has on the system cannot yet be thoroughly explained, still the fact is sufficiently established that scrofulosis as well as pulmonary consumption are much more frequent in asylums for foundlings and orphans, in reformatories and prisons, and among artisans Avho have to work the whole day in closed rooms, than in those who are much in the open air. Tlie objection that the fre- quency of scrofulosis and pulmonary consumption in such places is caused by other agencies than the want of fresh air, and especially by bad and insufficient food, does not stand the test of experience. The inhabitants of many poor villages are, on an average, much worse off with regard to food, and are exposed to more numerous causes of disease, than those who are detained in prisons and reformatories, without being, in the same degree as the latter, liable to these diseases. Too little regard has hitherto heeiipaid^ in practice , to these striking facts. Numberless delicate and weakl}' children with protracted catarrhs, chronic eruptions on the skin, swelled lymphatic glands, etc., are every year sent to the sea-side or a salt-spring for a few weeks, but during the rest of the year they are allowed to sit for six hours every day in school, and do their tasks at home besides, to have private lessons, to play on the piano, etc. — provided only they take a good deal of cod-liver oil, as if cod-liver oil could take the place of fresh air. With this prejudice among physicians, which is certainly not exaggerated, it is no wonder that many anxious mothers do not scruple to keep their children altogether indoors during winter. Only where the injurious consequences of such a measure are particularly visible, on account of the length of the winter — as, for instance, in Russia — it is a pretty general custom to send to the South, dm'ing the winter months, not only invalids who are already consumptive, but also those in whom a consumptive tendency is suspected. It would be desirable were a similar practice introduced among us also : the school hours should at once be reduced as soon as their injurious influence becomes apparent, and, where^■cr the circumstances allow it, weak and sickly children who have a tendency to catch colds, or who are scrofulous, should, until their health has become more 64 PULMONARY CONSUMPTION. confirmed, be sent, during tlie nortlierly winter, to countries where tliey can every day run about in the ojDen air. I must coiifess that I have met Avith obstinate opposition when I made sucli proposals, which in our parts of Europe arc almost unheard-of; but in a series of cases in which I succeeded in having the schooling altogether discontinued for a time, and in making the children pass the greater part of the day in the open air, I have obtained results by Avhich I was myself surprised, and Avliich forced the conviction upon the parents that the success fully outweighed the heavy sacrifice which they had made. As soon as, in spite of the assurances to the contrary of Laennec, and of celebrated authorities of the most recent time, we are convinced that a jjrotracted bronchial catarrh frequently leads to consum})tion, it becomes obvious that the prophylaxis of pulmonary phthisis, besides the avoidance of influences on which the frequency of the disease depends in orphan asylums, prisons, etc., requires also measures by which — especially if a tendency to phthisis be present — bronchial catarrhs may be, if possible, prevented, and whereby even mild attacks of bronchitis may bo rapidly and completely removed. As an example that the precautions indicated from the former as well as from the latter point of view may be very well combined, we will only allude to the fact that almost all sailors, and many other practical people Avho must expose themselves to wind and weather, wear flannel shirts. When an acute catarrli e.vtends from the hroncld to the alveoli, it is often of momentous influence for the course and the ter- mination of the disease whether the physician who attends the case considers the catarrhal symptoms in the apices, the pyrexia, the severe disturbance of the general health, the rapid loss of strength, etc., as certain signs of a " tuberculosis," or whether he thinks that this set of symptoms may also depend upon a genuine catarrh and upon lobular pneumonia. In the first case, strict measures are, as a rule, considered useless, and their enforcement unnecessary. The patient is allowed to follow his em2)loyment until the rising pyrexia and the increasing debility force him to remain at home, or until haemoptysis, ])Icuritic pains, the appearance of dulness over the chest urgently demand that the supposed " secondary" pneu- TREATMENT. 65 monic and pleuritic processes be submitted at least to a sympto- matic treatment. It will not be said that I exaggerate ; — let us be sincere! Is not this ^^ laisser aller'''' practice, founded on reasoning, of everyday occurrence with regard to the affections under discussion ? It is seldom that a medical man reproaches himself for having, by his carelessness, been guilty of the de- velopment of a phthisis florida ; so firmly rooted is the conviction that in this form of pulmonary phthisis also, the cause of the disease is an infiltration of the lung with a new growth, against Avhich treatment is completely powerless. It is true, even in case the physician should have fully recog- nised the nature of the disease, he will not be able to cut it short at once ; but still he has every reason to give the strictest orders, he must do everything in his power to protect the patient from injurious influences, and to place him under such conditions as may be expected to put a stop to the further extension of the pneumonic process, and prevent its termination in cheesy infil- tration and disintegration of the lung-tissue. The results follow- ing such measures, by which alone regard is had to the present state of pathology, and by which the valuable labours of Virchow, Maier* Colberg,^ and others receive their practical application, confirm in a striking manner the correctness of the views brought forward by those observers. Let any one make the experiment of having patients with the supposed signs of a commencing pul- monary tuberculosis strictly confined to their beds for a time, forbidding them all unnecessary talking and coughing, covering their chest with poultices, ordering a local abstraction of blood by leeches or cupping on the first appearance, and on every re- currence, of pleuritic pains, and he will soon satisfy himself that many a patient gets well who would formerly have been assumed to be the subject of tuberculosis, and therefore incurable. I am fully convinced, from my experience of the last few years, that in former times I have lost many a patient from galloping con- sumption only because I considered him lost from the very first, and because I did not treat him as a patient who is sufiering from pneumonia, but as one in whose lungs a new growth has * Mittheilungen aus dem pathologishen Institut in Freiburg, von Rud. Maier. t Deuteches Archiv fur Klinische Medicin, Vol. II., 4, p. 468. F 66 PULMONARY CONSUMPTION. been developed, the extension and further changes of which it was beyond medical art to prevent. The treatment just alluded to must also be urgently recom- mended for the exacerbations ivJdch occur in the course of a chronic pulmonary co7isumptlon with symptoms of more intense pyrexia. We can prove, by a great number of recorded cases, how great, even in such conditions, is the influence of a treatment which takes into account the inflammatory nature of the lung-disease. In the clinique at Tubingen, which principally gets its patients from the population of the neighbouring villages, it is common for phthisical patients to be, during several years, repeatedly admitted for a short time. In these cases it is of quite frequent occurrence that, in the few weeks during which they stay in the Hospital and are treated in the above manner, the fever, the de- bility, and the emaciation which, on their admission, have often reached such a degree that the worst might have been anticipated, completely disappear, and that the patients themselves ask to be dischai'ged, in order to return to their occupations. Often enough, it is true, a short time only elapses before they return for re- admission with intense pyrexia, great debility, and a loss in weight amounting to 8 or 10 pounds. But besides the expe- rience gained in hospitals, that also of private practice has convinced me of the great advantage derived from acknow- ledging that the "hectic" fever of phthisical patients is a symptom of a chronic inflammation of the lung, and fi'om taking its intensity, in the same Avay as we do with the height of fever in acute pneumonia, as a measure for the intensity and for the further spreading of the pneumonic processes It is a fact of everyday occurrence, that consumptive patients in the better classes, even when they have considerable pyrexia in the even- ing hours, arc not advised, with sufficient urgency, by their physicians to give up their occupations, to discontinue their going to the office, and to keep away from over-heated and smoke-filled clubs and coffee-houses. Often enough, the exten- sion of chronic inflammatory processes, and their termination in breaking down, are essentially furthered by those very influences to which the patients expose themselves on those occasions, and which are most injurious to the diseased lungs ; whilst by care- fully avoiding them, by strict rest, an equable temperature, the application of poultices, etc., the disease is not unfrequently TEEATMENT. 67 arrested and an improvement obtained in a surprisingly short time. I observed the following striking case at Greifswald : — Mr, v., a joiner and furniture-dealer, in good circumstances, an active business-man, but addicted to the pleasures of a good table and of jovial society, had for years been suflFering from a chronic pulmonary phthisis with large cavities in both apices. During the summer months he used generally to be in a tolerable state of health, and regularly took a course of mineral waters, most frequently at Ems. During winter he got worse and complained much, but still did not keep away from his warehouse, nor discontinue the daily visit to his club. In the winter of 1858 I had lost sight of him, as he had ap- plied to another physician, because I had refused to comply with his wishes and visit him regularly. One day he sent for me ; I was sur- prised by his appearance : he was emaciated in the extreme, and told me he had lost fifteen pounds in weight since the autumn. In the evening his pulse numbered 110 to 120, his temperature over 39° C. (102-2° F.) ; but even in this state he had daily attended at his office, and had also daily gone to his club. He had taken, as was shown by his prescriptions, large quantities of medicine during the last few months, so I ordered that, first of all, every medicine should be discon- tinued, but that the patient should keep to his bed for a week, that he should speak as little as possible, that he should suppress the inclination to cough, and cover his chest with a poultice. JMr. V. became very desponding on hearing this advice. He declared, with loud lamenta- tions, he was sure he should never leave his bed again, and should succumb to his illness in a short time. But even after the lapse of a week the pyrexia was markedly diminished, the rather profuse night- sweats had disappeared, the appetite had returned. Mr. V. got rapidly better, and lived three years longer. Should the desired effect not be obtained b}' keeping all in- jurious influences away from the inflamed lung, by a moderate diaphoresis, by the application of poultices to the chest, etc., and should the pyrexia remain at all considerable, no time ought to be lost in using cmti-jyT/retic remedies. These remedies have just as little direct influence on the chronic pneumonia of consumptive patients as they have on acute pneumonia, on continued fever, and other diseases, against which they are much recommended and employed, although frequently without a clear idea of Avliat they can effect. The fact being once recognised, that the loss of mucus and cells, which in simple bronchial catarrhs is often much more profuse, has only a small share in the wasting of consumptive patients, and that the 2'i/^"<^''^'^'<^ is their worst enemy, it becomes a matter of course to attempt by every F 2 68 PULMONARY CONSUMPTION. means to combat this enemy. Among the remedies which are in many cases successful in reducing the increased production of heat and tlie temperature of the body, although the original disease continues, digitalis and quinine justly enjoy a great reputation. We employ them very frequently in phthisical patients, if wo have not succeeded in subduing the pyrexia by the means above alluded to ; and pills which contain one grain of quinine, half a grain of digitalis and a quarter of a grain of opium, and of which one is taken four times a day, are one of the most frequent prescriptions of our clinique. At times when I am much consulted by phthisical patients, I often prescribe these pills three or four times on the same day. In the Hospital we discontinue the pills as soon as a marked decrease of the temperature and of the frequency of the pulse is noticeable, and we return to their use as soon as their effect has again disappeared. In my consulting practice I have repeatedly seen that patients quickly learn to judge by their own experience when it is time to discontinue the pills and when to return to their use. Wo pass immediately from the consideration of the anti- pyretic treatment of phthisis to that of the dietetic rules to be given to the patients, and wo do this for the same reason as, above, among the symptoms we considered the wasting immedi- ately after the pyrexia. A man who has pyrexia which rapidly consumes his body, requires much more urgently a supply of fresh nutritive material than one Avho has no pyrexia. A patient suffering from phthisis has sometimes pyrexia for months, so that the danger of being consumed by the fever is much greater for him than for a patient who is affected with some acute disease of short duration. It results from this, that we have particular reasons for supplying phthisical patients with abundant and appropriate food. It has been frequently asserted that food increases the pyrexia; but this is far from being proved, and — not to speak of the practice which is usual in England — even in our country the patients are only placed on the so-called " fever-diet," i. e. all nutritive food is kept away from them, till such time only as it becomes clear that danger arises therefrom. As soon as this becomes apparent, that alleged rule of experience is completely TREATMENT. 69 set aside by those who have charge of the patient, or, rather, they act in direct opposition to it. With regard to the selection of the appropriate food for phthisical patients, the ancient precepts, which are partly in- herited from rude experience, completely agree with the physio- logical laws of nutrition. All articles of food which are chiefly recommended for phthisical patients, contain large quantities of fat or fat-forming material, and comparatively few nitrogenous substances. With this selection agrees the fact which has been experimentally discovered, that when nitrogenous substances are abundantly taken, the production of urea, viz. the transformation of nitrogenous substances, is increased, but that, when fat and fat-formiiig material are liberally supplied at the same time, the change and waste of those organs and tissues which are by far the most important for the system is, on the contrary, diminished. For this reason, a free use of milk, to which children owe the round forms of their limbs, and which too stout persons justly avoid, cannot be too warmly recommended. But it is quite superfluous and wrong to take the cheese away from the milk and to give the latter as whey, unless it be — as, however, cer- tainly but very seldom occurs — that whey agrees, whereas milk disagrees, with the patient. When in numerous cases I recom- mend to my patients to take, three times a day, half a pint of milk " from the cow," I have no other purpose in doing so than to prevent its being skimmed — and this, I need hardly say, is impossible immediately after the milking. Cod-liver oil I esteem very highly, but it can be completely replaced by the much less nauseous and, for the stomach, less troublesome malt-extracts which, instead of fat, contain fat- forming substances in a form to be very easily assimilated. Grapes also may be recommended instead of the cod-liver oil, although, strange to say, they are reputed with many physi- cians to purge and to " dissolve," for which qualities they are not seldom ordered after a course of Marienbad or Karlsbad waters. By taking three to four pounds daily of the sweet grapes at Vevey, Montreux, etc., almost all persons will increase in bulk and weight within a few weeks, and if the intestines pre- viously have been sound, diarrhoea occurs but very seldom. For the rest, that form of phthisis which consists in pneu- monic processes must he treated accoixling to the same principles 70 PULMONARY CONSUMPTION. lohich hold good for the treatment of catarrhcd inflammations confined to the hronchial mucous membrane. It would lead us beyond our task to enter more minutely into the questions under what conditions the administration of so-called exj)ectorant remedies is indicated ; under what conditions resinous and balsamic substances or nar- cotics are appropriate ; in what cases the inhalation of pulverised liquids should be used, etc. In our opinion, the use of alkaline muriatic springs has, in numerous patients, a really curative influence, not only on the prodromal catarrh, but also on the phthisis itself — an influence which, however, is completely denied by sceptical physicians and by those who are biassed by the old doctrine. That the use of the waters of Ems, Obersalzbrunn, etc., is contra-indicated by the presence of pyrexia, belongs, like so many other things, to the category of those facts of which a wrong explanation has been given. It is not the mineral waters, but the journeys to those watering-places, and the usual promenades there, which disagree with the jiatients. A patient with pyrexia of any con- siderable degree is, as we have shown, to be confined to his room, or, rather, to his bed. But, just as in the treatment of a simple catarrh it is of much greater importance to keep off fresh injurious influences from the patient than to administer drugs, so the same holds good with regard to phthisis which has its foundation in catarrhal pneu- monia. To most phthisical patients the advice would have to be given to pass the greater part of a northerly winter in their room, which ought to be kept at the most equable temperature possible, if the very important objections which we have fully considered above were not opposed to such a measure. The difficulty of injuring the patient in one way or the other is evaded by making him escape the northerly winter until his health has become stronger, viz. by sending him, during winter, to places in which he can spend the greater part of the day in the open air, without risk of catching cold and without breathing a bleak and cold air. This, according to our opinion, is the only proper meaning of ordering a charige of climate to a patient. We must not neglect to induce the patients in question, if their means at all allow it, to make this sacrifice ; but, at the same time, Ave ought to tell them the plain truth, in order that they may not be under the impres- sion that the air in the places to which they are sent contains TREATMENT. 71 peculiar curative substances for their diseased lungs. Only when the patients themselves know what is the real object of their going to those places, will they live at Nice, Mentone, Pau, Pisa, as well as in Algeria, at Cairo, and in Madeira, with those pre- cautions which alone make success possible. Otherwise it would often have been better for them if they had remained at home. In acting on these principles, it is a matter of course that the patients be sent in the autumn, before the cold season commences, to Soden, Badenweiler, Wiesbaden, and especially to the Lake of Geneva, where they may, at the same time, take grapes, and where they are as well until the commencement of winter as with us in summer. It is only very intelligent and prudent patients, of whom we may be certain that they will remain at home on cold days, that may be allowed to pass the winter at Nizza, Mentone, Pisa, or Pau, etc. But it is always better to send people whose means are sufficient to Algeria, Cairo, or Madeira during Avinter. The advantages of one place over another are as yet by no means sufficiently established, and the indications which have been formed as to the choice of Madeira, Cairo, or Algeria, according to the diffi3rent individual peculi- arities or the different course of the disease, are so loose and uncertain that they are not of much value. The chief point, under all circumstances, is tltat tlie 2Miie>its, ivherever they may he, live prudently and he under the care of an intelligent and firm physician. Against that form of phthisis which consists in a pn'j^iary tuhercidosis, as well as against the tuberculosis lohich has heoi developed in the course of phthisis, treatment is indeed impotent, and we arc simply limited to the palliation of the most trouble- some symptoms. It is strange that anti-pyretic remedies have comparatively little effect on the fever which is due to true tubercle. If we have come to the conviction that a consumptive patient has tubercles, we ought not to send him to Nice, Cairo, etc., but ought to let him live his last days among his friends and die in his own house. This applies, however, only to those cases in which the diagnosis of tubercles is beyond any doubt. LAWS THE NEW SYDENHAM SOCIETY. I. — The Society is instituted for the purpose of supplying certain acknow- ledg-ed deficiencies in the existing means of diffusing medical literature, and shall be called " The Xew Sydenham Society." II. — The Society shall carry out its objects by a succes.sion of publications, of Avhich the following shall be the chief: — 1. Translations of Foreign "^"orks, Papers, and Essays of merit, to be reproduced as early as practicable after their original issue ; 2. British Works, Papers, Lec- tui'es, &c., which, whilst of great value, have become from any cause difficult to be obtained, excluding those of living authors ; 3. Annual Volumes consisting of Reports in Abstract of the progress of the different branches of Medical and Surgical Science during the year ; 4. Dic- tionaries of Medical Bibliography and Biography. Those included under Nos. 1 and 2 shall be held to have the first claim on the attention of the Society, and the carrying out of those under 3 and 4 shall be cousidered dependent upon the amount of funds which may be placed at its disposal. III.— The Subscription constituting a ilcmber shall be One Guinea, to be paid ill udrroice on the 1st of January annually, and it shall entitle the subscriber to a copy of every work published for that year. No hooks shall be issiud to any Member until his su.bscri2}tionfor the year has been paid. IT.— The Officers of the Society shall be elected from the Members, and shall consist of a President, Sixteen Vice-Pre- sidents, a Treasurer, a Secretary, and a Council of Thirty-two ; in whom the power of framing bye-laws, and of direct- ing the affairs of the Society, shall be vested. Twelve of the Council shall be Pro\'incial Residents. V. — Five Members of the Council shall form a quorum. VI. — The Officers of the Society shall be elected by ballot at the General Anni- versary Meeting of the Society. Ballot- ing lists of Officers proposed by the Council, w'ith blank places for such al- terations as any Member may wish to make, shall be laid on the Society's table for the use of Members. VII. — The President, Vice-Presidents, and Coimcil shall be eligible for re-elec- tion, except that of the Vice-Presidents four, and of the Council eight, shall retire every year. VIII. — The Council shall appoint Local Honorary Secretaries wherever they shall sec fit. IX. — The business of the President shall be to preside at the Annual and Extraordinary Meetings of the Society : in his absence one of the Vice-Presidents, or the Treasurer, or any Member of the Council chosen by the Members present, shall take the chair. X. — The Treasurer, or some person appointed by him, shall receive all moneys due to the Society. XL — The money in the hands of the Treasurer, which shall not be immediately required for the uses of the Society, shall be vested in such speedily available secu- rities as shall be approved of by the Council. b 74 THE NEW SYDENHAM SOCIETY. XII. — The Council sliall select the Woi-ks to be published by the Society, and shall make all arrangements, pecu- niary or otherwise, in regard to their publication. In the event of any Mem- ber of the Council being appointed to edit any work for the Society, for which he is to receive pecuniary remuneration, he shall immediately cease to be a Mem- ber of the Council, and shall not be eligible for re-election till after the pub- lication of the "Work. XIII.— The Coimcil shall lay before the Members at each Anniversary Meeting a report of their jjroceedings during the past year, and also an account of the receipts and expenditure of the Society ; and shall further cause to be printed, and cii-cidated anioug the Members, an abstract of such report and accounts immediately after such Anniversary Meeting. XIV. — Tlie annual accoimts of the re- ceipts and expenditure of tlie Society shall be audited by a committee of three Members, selected at the preceding Anni- versary Jleeting from among the Mem- bers at large. XV. — The Secretaiy shall have the management of the general correspond- ence of the Society, and of such other business as may arise in carrying out its objects. XVI. — The Local Secretaries shall fur- ther the objects of the Society in their respective districts, and shall be in com- munication with the Metropolitan Secre- tary. XVII. — The Anniversary Meeting shall be held in the same town as, and at the time of, the Annual Meeting of the British Medical Association, notice of it having been given to all Members at least a week before the day fixed on. XVIII. — The Members generally shall be invited and encouraged to propose Works, &c., and to make any suggestions to the Council they may think likely to be useful. XIX.— The Works of the Society shall be printed for the Members only. XX. — No alteration in the Laws of the Society shall be made, except at a General Meeting. Notice of the altera- tion to be proposed must also have been laid before the Coimcil at least a month previously. XXI. — The Council shall have power to call a General Meeting of the Members at any time, and shall also be required to do so within three weeks, upon receiving a requisition in writing to that effect from not less than twenty Members of the Society. XXII. — All special General Meetings of the Society shall be held at such place as the Council may appoint. XXIII. —The Council shall meet at least once in two months, unless by special resolution to the contrary. I EEPOET Presented to the Eleventh Annual Meetiiig, held at Leeds, July^ 1869. The Covmcil lias tlie pleasure to report tliat the conclusion of the Society's eleventh year finds it \\\ its usual condition of prosperity. The income for 1868 was nearly equal of that for 1867, and exceeded that for 1866, amounting in total to £2,951. During the year, including the Catalogue of Portraits of Skin Diseases, fiye volumes \vere issued, thus making a total of forty volumes in ten years. Under the term "volume" are here comprised the Fasciculi of the Atlas of Skin Diseases, the pub- lication of which is much more expensive than that of an ordinary printed book. Although during each of the last two years the expenditure has somewhat exceeded the income, and thus the balance in hand has been reduced, yet the financial state of the Society is such that the Council feels no anxietj^ as to its being- able, in the future, to continue the annual average of four volumes. The balance now in hand amounts to nearly £1,000, and in addition to the usual income from annual subscriptions, the Society possesses a valuable property in stock in hand. The demand for back volumes is still steady. Ten complete sets were required during the year. The Council has recently adopted for translation several important works, which will, it believes, be acceptable to the profession. Amongst these are : PROFESSOR NIEMEYER'S LECTURES ON PHTHISIS. WUNDERLICH'S TREATISE ON TEMPERATURE IN DISEASE (being a complete guide to the use of the Thermometer in Medical Practice). STRICKER'S MANUAL OF HUMAN AND COMPARATIVE HISTO- LOGY. This work will be a complete treatise on the Microscopic Anatomy of the tissues, and will be produced (under the Editorship of Dr. Strieker) by a staff of authors, which includes most of the distin- guished histologists of Germany. Only the first part is as yet published. Its translation has been entrusted by the Council to Mr. Henry Power, the Editor of the last edition of Carpenter's Physiology. , The first volume will probably be ready early next year, and the issue of the English edition will be almost simultaneous with that of the original. The Council has also under consideration several other im- portant works. During the present year three volumes have already been issued, and the series will be comj^leted by the ]N[inth Fasciculus of the Atlas of Skin Plates. The third volume of Trousseau's Clinical Medicine will be ready early in 1870. hi LIST OF OFFICERS FOR 1869-70. *JOHN HILTON, Esq., F.E.S. HENEY W. ACLAND, M.D., F.E.S. | W. D. HUSBAXD (Oxford). THOMAS E. BEATTY, M.D. (Dubliu). JAMES E. BENNETT, M.D. CHARLES CHADWICK, M.D. (Leeds). EDWAED CHARLTON, M.D. (Newcastle). *Sir DOMINIC COERIGAN,M.D., Bart (Dublin). SAMUEL HEY, Esq. (Leeds). JAMES PAGET, Esq., F.E.S. (York). *W. D. MOOEE, M.D. (Dublin). *G. E. PAGET, M.D. (Cambridge). THOMAS B. PEACOCK, M.D. FRANCIS SIBSON, M.D., F.E.S. Sir J. Y. SIMPSON, M.D. , D.C.S., Bart. (Edinburgh). (Deceased.) Sir THOMAS WATSON, M.D., F.E.S. Bart. C. J. B. WILLIAMS, M.D., F.E.S. *EEASMUS WILSON, Esq., F.E.S. JAMES ANDEEW, M.D. *FEANCIS E. ANSTIE, M.D. JOHN BAECLAY, M.D. (Leicester). WARBURTON BEGBIE, M.D. (Edinburgh). CHARLES BROOKE, Esq., F.R.S. THOMAS CAMMACK, M.D. (Spalding). THOMAS M. DALDY. M.D. HERBERT DAYIES, M.D. *J. LANGDON H. DOWN, M.D. ROBERT DRUITT, M.D. A. E. DURHAM, Esq. *C. HILTON FAGGE, M.D. *R. WILBEAHAM FALCONER, M.D (Bath). SAMUEL FENWICK, M.D. T, BELL FLETCHEE, M.D. (Birmingham). E. C. FURNER, Esq. (Brighton). €mndL CHRISTOPHER HEATH, Esq. M. H. HIGGINBOTTOM, Esq. (Nottingham). *J. HUGHLINGS JACKSON, M.D. T. CARR JACKSON, Esq. J. C. LANGMORE, M.B. ARTHUR LEARED, B.A., M.D., M.R.I. A. G. ]\rAY, Esq. (Reading). J. AV. OGLE, M.D. OLIVER PEMBERTON, Esq. (Birmingham). W. ROBERTS, M.D. (Manchester). * GEORGE SHANN, M.D. (York). * SEPTIMUS W. SIBLEY, Esq. A. P. STEWART, M.D. *WILLIAM TUENEE, M.B,, F.E.S.E. (Edinburgh). HEEM.iNN 'WEBER, M.D. W. SEDGWICK SAUNDERS, M.D., 13, Queen Street, Cheapside, E.C. J. S. BEISTOWE, M.D. | *THOMAS BRYANT, Esq. ANDEEW CLARK, M.D. li0jT» ^tcxthx^. JONATH.YX HUTCHINSON, Esq., 4, Finsbury Circus, E.C. ME. H. K. LEWIS, 136, Gower Street, W.C. * Those whose names are marked with an Asterisk -were not in Office last vear. ►5J w o «:> CO c" -(< lO 50 CO -; r: oQ «: O Sf^ ■ a 2 h^Ph<^ P^Ph .2 .S 1^ 3 ^ •? 5h ? 5 5 s p - -< cc Eh (^ I— I *< -^ F!^ copq fcD H §2 c^i >-'; t^ CO cc i.'^ C2 -^ -ti c^i c; c>i ~ o '-"^ Oi-l«2COOO'-l!»'^1C5-*lTtiOO(MO Ot-- |— I 1— 1 (30 t>. l-» O SC »0 O J^ 1— I !>< O M .CsOi— itMCO'^'fJCDl^COO ^<; .*oooocoooococDOr:)c^' COCXICCIODOOOOOOOOCOOOOO^^ — ;i; ;i; ;::;;-; •-« ^ o ^ ^ p; . «« V-. cii (V. C; "¥; < ,3 .O .C ,0 .O ,C ,0 ,C ,0 t„ „ „ C-1 lO 1^ CO GO lO Ci M^l-* ,'-' r*^ >2 1-1 ■* C5 CO -Q H 5 1-^ ?! 2 ^1 LIST OF WOKKS ALREADY ISSUED. ON SYPHILIS IN INFANTS. By Paul Diday. Translated by Dr. Whitley. "Tliu work of M. Dicky is of great merit; it contaius all that has been written uu iufaiitilc syphilis, aud he i)iits the whole subject in a well-arvauged form for further investigation as well as present use." — British and Foreign Medico-Chirur- gical Review. With Woodcuts. ON THE MORE IMPORTANT DISEASES OF WOMEN AND CHILDREN. A\'itli otlicr Papers, by Dr. Goocn. lleprinted ; with a Prefatory Essay by Dr. Egbert Eergusox. " The work of Dr. Gooch is so well known and highly appreciated by every lover of medical literature, that we need say nothing in its praise. It has been before the world for thirty years, aud only one opinion has been expressed upon its merits. "Wc cannot tmt consider, therefore, that tiie Council of the New Sydenham Society has done weU to republish it, more especially as the Council has had the good fortune to persuade Dr. Robert Ferguson to furnisli an introductory essay on the author's life and writings." — Lancet. MEMOIRS ON DIPHTHERIA : Containing Memoirs by Bretgnneatj, Trousseau, Daviot, Guersant, L'oucnuT, Empis, etc. Selected and Translated by Dr. E. H. Semple. " Bretouneau's Memoir- must be considered the fullest and most searching that has yet appeared in any country on this extraordinary disease." — British Medical Journal. "Like honour is due to il. Bretonneau, for his admirable investigations. . . . His Treatise on Diphtheria constitutes the greater part of the volume recently pub- lished by the New Sydenham Society. Of the remaining Memoirs each contains much valuable material. . . . There is no part of the volimie which will better repay study than the researches of M. Empis." — 3Iedico-Chirurgical Eevicw. With Lithographs. ON THE MINUTE STRUCTURE AND FUNCTIONS OF THE SPINAL CORD. By Professor Schrceder van der Kolk. LIST OF WOKKS ALREADY ISSUED. 79 JVith Lithographs. ON THE MINUTE STRUCTURE AND FUNCTIONS OF THE MEDULLA OBLONGATA, AND ON THE PROXI- MATE CAUSE AND RATIONAL TREATMENT OF EPILEPSY. By Pj-ofessor Sche(eder tan dee Kolk. Translated by Dr. W. D. Mooee, of Dublin. " This volume aloue, illustrated as it is by such admirable engravings of the anatomy of the nervous system, is worth the whole annual subscription." — British Medical Journal. EXPERIMENTAL RESEARCHES ON THE EFFECTS OF LOSS OF BLOOD IN INDUCING CONVULSIONS. By Drs. Kussmatjl and Tenner. Translated by Dr. Beonner, of Bradford. With Numerous Woodcuts. ON THE PROCESS OF REPAIR AFTER RESECTION AND EXTIRPATION OF BONES. By Dr. A. AVagnee, of Berlin. Translated by Mr. T. Holmes. THREE MEMOIRS ON GLAUCOMA AND ON IRIDEC- TOMY AS A MEANS OF TREATMENT. By Professor Von Grjefe. Translated by Mr. T. "Windsor, of Manchester. " This is the fifth volume of the first year, and contains translations of tlu'ee important and well-known essays from the German." — Lancet. "The value — the great practical value — of these Memoir's will be admitted by every one who peruses them." — Medical Times and Gazette. Numerous Woodcuts. MEMOIRS ON ABDOMINAL TUMOURS AND INTUMESCENCE. By Dr. Bright. Beprinted from the "Guy's Hospital Reports," with a Preface by Dr. Bakiow. 80 THE NEW SYDENHAM SOCIETY. Witli Coloured Lithographs, and Numerous Woodcuts. A CLINICAL ACCOUNT OF DISEASES OF THE LIVER. By Professor Prekichs. Yol. I. Translated by Dr. Muechison. ."Frerichs' book is one of those Ireatises that will frequently be taken down from the* book shelves to be consulted, both by physiologists and physicians." — Lancet. " We shall look forward with interest to the completion of this very valuable addition to the Clinical History of Liver Diseases." — Medical Times and Gazette. A YEARBOOK OF MEDICINE AND SURGERY, AND THEIR ALLIED SCIENCES, for 1859. Edited by Dr. Haelet, Dr. Handfield Jones, Mr. Hulke, Dr. Geailt Hewitt, and Dr. Odling. " Our space will not admit of a further statement of the excellent character of the Yearbook, and the other works issued by the Xew Sydenham Society, but we would strongly urge every member of the profession, who lias the advancement of medical knowledge at heai't, to lose no time in forwarding his name, should he not akeady have done so." — London Medical Journal. THE FIRST FASCICULUS OF AN ATLAS OF PORTRAITS OF SKIN DISEASES; Comprising Three Plates, copied from those of Hebra, and illustrating : —Plate I. FAYUS. Plate II. TIXEA TONSURANS. Plate III. LUPUS EXULCERANS. A HANDBOOK OF THE PRACTICE OF FORENSIC MEDICINE, BASED UPON PERSONAL EXPERIENCE. By J. L. Caspek, M.D., late Professor of Forensic Medicine in the University of Berlin. Yol. I. Translated by Dr. Gr. "VY. BALrotrn, of Edinburgh. " This volume must be regarded as a valuable and judicious addition to the pub- lications of the Society from which it emanates. The advantages to be derived by the reader from its perusal cannot be over-estimated or too eagerly sought for." — Madras Qitarterhj Jotirnal of Medical Science. ON THROMBOSIS OF THE CEREBRAL SINUSES. By Professor Yon Duscn. Translated by Dr. Whitley. LIST OF WORKS ALREADY ISSUED. 81 Numtrons IFoodaifs. CZERMAK ON THE PRACTICAL USES OF THE LARYNGOSCOPE. Translated by Dr. G. T>. Gibb. " "What has bceu given will, we trust, coiiYince any one who may hitherto have doubted the value of laryngoscopy, that it is a real acquisition. To those who are desirous of becoming more fully acquainted with the subject we strongly recommend the study of tlie work [Professor Czermak's] from which we have chiefly culled our extracts." — Medico-Chirtirgical Review, October, 1862. Four Litlwgraphs. SCHRCEDER VAN DER KOLK ON A CASE OF ATROPHY OF THE LEFT HEMISPHERE OF THE BRAIN. Translated by Dr. "W". Mooee, of Dublin. RADICKE'S PAPERS ON THE APPLICATION OF STATISTICS TO MEDICAL ENQUIRIES. Translated by Dr. Boxd. " We can hardly conceive an object to which the New Sydenham Society could better devote a portion of its rapidly-increasing resources than to the introduction of papers such as these to the profession. It is by such work as this that the Society is calculated to confer inestimable benefits on the profession of tliis country." — Medical Times and Gazette, January 2-5, 1862. Woodctlts. ESMARCH ON THE USES OF COLD IN SURGICAL PRACTICE. Translated by Dr. Montgomery. " Dr. Esniarch's treatise is of high practical interest." — British Medical Journal, December, 1863. A YEARBOOK OF MEDICINE AND SURGERY, AND THEIR ALLIED SCIENCES, for ISGO. Edited by Dr. Haelky, Dr. Haxdfield Joxks, Mr. Hulkk, Dr. Geaily Hewitt, and Dr. Sandekson. " This is, as it professes to be, an improvement on its predecessor. On the whole the editors have done their laborious work well." — British Medical Journal, Dec. 31, 1861. 82 THE NEW SYDENHAM SOCIETY. A SECOND FASCICULUS OF THE ATLAS OF PORTRAITS OF SKIN DISEASES, Comprising Plates from Hebra, illustrating : — Plate IV. PSORIASIS DIFPIJSA. Plate Y. ICHTHYOSIS. Plate YI. LUPUS SERPIGINOSUS ; ALOPECEA AREATA. IVoodcuts and Lithographs. THE SECOND AND CONCLUDING YOLUME OE FRERICHS' CLINICAL ACCOUNT OF DISEASES OF THE LIVER. Translated by Dr. Mukchison-. " The Ilrst instalment of Frcrichs' wcU-knowai work was so good that some little impatience was natural as regarded the remainder. Having received the second volume, we have to thank both author and translator for the very accei^tablc gift, this treatise being about one of the most important that the recent schools of Germany have produced. . . . The members of the New Sydenham Society could not receive anv better return for their subscriptions." — Lancet. A YEARBOOK OF MEDICINE AND SURGERY, AND THEIR ALLIED SCIENCES, for 1861. Edited by Dr. Haeley, Dr. Handfield Jones, Mr. Hulke, Dr. Geaily Hewitt, and Dr. Sandeeson. A THIRD FASCICULUS OF THE ATLAS OF PORTRAITS OF SKIN DISEASES, Comprising Plates, illustrating :— Plate VII. LUPUS VULGARIS ET SERPIGINOSUS (Cicatrising). Plate VIII. HERPES ZOSTER FRONTALIS (affecting the Erontal and Trochlear Branches of the Fifth Nerve). Plate IX. MOLLUSCUM CON- TAGIOSUM. A, on a Child's Pace ; b, on the Breast of the Child's Mother; c, Anatomical Characters of the Tumours; d, Microscopic Characters. " They are better, to our mind, than any other plates in use amongst us ; and there cannot be a question as to the Society's issue being as popular as it is usefid." — Lancet. LIST OF WOKKS ALREADY ISSUED. 83 A HANDBOOK OF THE PRACTICE OF FORENSIC MEDICINE, BASED UPON PERSONAL EXPERIENCE. By J. L. Caspek, M.D., Professor of Eorensic Medicine iu the University of Berlin. Yol. II. Translated by Dr. G. W. Balfouk. With Two Tallcs and Nine Woodcuts. THE AURAL SURGERY OF THE PRESENT DAY. By AY. Keamee, M.D., of Berlin. Translated by Henkt Power, Esq., F.R.C.S., M.B. A YEARBOOK OF MEDICINE AND SURGERY, AND THEIR ALLIED SCIENCES, for 1862. Edited by Dr. Moxtgoiieey, Dr. Haxdfield Jones, Mr. Windsor, Dr. Geaily Hewitt, and Dr. Sandeeson. With Four Lithographs, and numerous Woodcuts. A GUIDE TO THE QUALITATIVE AND QUANTITATIVE ANALYSIS OF THE URINE. By Dr. C' Neubatjee and Dr. J. Yogel. Eourth Edition, considerably enlarged. Translated by "VYilliaji 0. Makkham, F.R.C.P.L. " The New Sydeuham Society have conferred a benefit, not only on their own subscribers, but on the whole profession iu this coiuitry, by publishing the work of Brs. Neubauer and Vogel." — Medical Times and Gazette. " It is one of those works iu which there is not an unnecessary line, nor even a word. It is quite a text-book upon urinology for the scientific physician, and may be handled likewise by the youngest student." — Lancet. A HANDBOOK OF TtlE PRACTICE OF FORENSIC MEDICINE, BASED UPON PERSONAL EXPERIENCE. By J. L. Caspee, M.D., late Professor of Medical Jurisprudence in the University of Berlin. Translated by G. W. Baleouk, M.D. Yol. III. [The next volume (Yol. lY.) will conclude Professor Casper's work.] " Casper's great work, based as it is upon a minute and laborious observation of facts, must prove the most trustworthy guide iu the interpretation of the ofltimcs difficult quefstions which the medical jurist is called upon to fiolye."— Lancet. 84 THE NEW SYDENHAM SOCIETY. ON THE ANOMALIES OF ACCOMMODATION AND REFEACTION OF THE EYE, WITH A PRELIMINARY ESSAY ON PHYSIOLOGICAL DIOPTRICS. By E. C. DoNDEKS, M.D., Professor of Physiology and Ophthalmology in the University of Utrecht. Translated from the Author's Manuscript, by "VV. D. Mooee, M.D. " This splendid monograph, from the hand of the accomplished professor of phy- siology and ophthalmology of Utrecht, will be liailed as a boon by all lovers of ophthalmic science." — Lancet. " This is one of the most important volumes published by the Xcw Sydenham Society. Elaborated by a master mind, translated by a skilled and practised hand, this work, in which will be found the results of many years' experience, and of the examination of many thousand eyes, marks quite a new era in ophthalmic science. No lately published work has done so much to advance the progress of this branch of surgery as this one of Professor Bonders, so ably translated for us by Dr. W. D. Moore." — Dublin Quarterly. " Professor Bonders has succeeded in almost clearing up a class of diseases prcA i- ously in extreme confusion. This work well deserves the epithet 'exhaustive' ; it is equally scientific and practical, full, yet not diffuse, clearly and pleasingly written, and freely illustrated by cases and woodcuts. This is imdeniablj one of the most able and valuable works published for many years. We must not neglect to add that the translator appears to have most ably and satisfactorily performed his very tedious and difficult task. Most heartdy do we tliank the author for the great benefit he has bestowed on the medical profession, and the New Sydenham Society lor the im- pulse it has given by this important publication to British Ophthalmology." — Medico- Chirurgical lieview. A YEARBOOK OF MEDICINE, SURGERY, AND THEIR ALLIED SCIENCES, for 1863. THE FOURTH FASCICULUS OF THE ATLAS OF PORTRAITS OF SKIN DISEASES, Comprising original Plates, illustrating : — Plate X. MORBUS ADDISONII. Plate XI. LEUCODERMA. A HANDBOOK OF THE PRACTICE OF FORENSIC MEDICINE, BASED UPON PERSONAL EXPERIENCE. By J. L. Casper, M.D., late Professor of Medical Jurisprudence in the University of Berlin. Ti'anslatcd by Gr. W. Balfour, M.D. Vol. lY. A YEARBOOK OF MEDICINE AND SURGERY, AND THEIR ALLIED SCIENCES, for 1864. Edited by Mr. Hintox, Dr. Hanefield Jone.s, Mr. Windsor, Dr. Meabtjen Bright, and Dr. Hilton Eagge. LIST OF WORKS ALREADY ISSUED. 85 THE FIFTH FASCICULUS OF THE ATLAS OF PORTRAITS OF SKIN DISEASES, Comprising original Plates, illustrating :— Plato XII. PEMPHIGUS. Plate XIII. PITYRIASIS YERSICOLOR. Plate XIV. PSORIASIS INYETERATA. CLINICAL MEMOIRS ON DISEASES OF WOMEN. By Drs. Bernutz and Goupil. Translated and abridged by Dr. Meadows. Yol. I. " Tlie careful study of these valuable IMemoirs is imperative in all wlio are inter- ested in gyna?cology." — Lancet, October, 1866. THE SIXTH FASCICULUS OF THE ATLAS OF PORTRAITS OF DISEASES OF THE SKIN, Comprising original Portraits, illustrating : — Plate XY. Eczema, Im- petiginoides on Face of Adult. Plate XYI. Eczema on the Face, etc., of Infant ; Eczema Rubrum on Leg of Adult. Plate XYII. Psoriasis of Hands and Finger-Xails ; Syphilitic Psoriasis of Finger-Xails ; Congenito-Syphilitic Psoriasis of Finger- and Toe- Nails ; Onychia Maligna ; Chronic General Onychitis. ON DISEASES OF THE SKIN, INCLUDING THE EXANTHEMATA. By Professor Hebka. Yol. I. Translated and Edited by Dr. Hiltox Fagge. " Of all the works produced by the New Sydenham Society this is one of the most valuable and most welcome. . . . It is to be remarked that this book is not a mere translation of the German work ; it is a new and revised edition, undertaken by the aiitlior for his English brethren." — 3fcdk'al Times and Gazette, April 27, 1867. " Tlie Xew Sydenham Society has done good service to the medical profession by undertaking the translation and publication of Professor Ilcbra's excellent work. In several respects the English edition is greatly superior to the original. In closing its pages we have but one regret, namely, that the New Sydenham Society does not embody the whole medical confraternity, so that every mcmbQr of om- noble profession might have on his bookshelves a copy of this most valuable book." — Journal of Gut a- neons Medieine, April, 1867. " The New Sydenham Society has given to the profession some most valuable works, but it has never done a better service than in giving the profession this tran- slation of Hcbra, the acknowledged leader at present of dermatologists. The chief value of the book is in his enormous clinical experience and close observation, in his anatomical and ph3-siological knowledge, and in his power of clear and accurate de- scription. The greatest credit is due to the translator. Dr. Fagge, who tells us in his Preface that every sheet of the translation has been read over and accepted by Professor Hebra." — Lancet. 86 THE NEW SYDENHAM SOCIETY. CLINICAL MEMOIRS ON DISEASES OF WOMEN. By Drs. Beentttz and Goupil. Yol. II. Translated and abridged by Dr. Meadows. " Those members of om- profession whose engagements are too numerous to permit of lengthened reading, will be pleased with Dr. Meadows' excellent rendering of the original. Nothing of practical importance has been omitted, and instead of losing by the translation, the wholesome, necessary shortening has added life and pith to the work. It is one of the most painstaking, careful, exhaustive and practical treatises that has ever yet appeared ; and any general practitioner who is anxious to obtain a true knowledge of these diseases will consult without delay this neat volume." — Medical Mirror. " We have to thank Dr. Meadows for the careful arrangement of excellent in- dices to the subjects treated, and to the Bibliography, which add much to the value of the work. The text has been well translated, and though considerably abridged from the original, the material facts and arguments are throughout I'airly brought forward ; and we think the members of the New Sydenham Society will be well satisfied \nth these volumes." — Mcdico-Chirurqical Revinv. A MANUAL OF MENTAL PATHOLOGY AND THERAPEUTICS. By Professor Griesinger. Translated by Dr. LocKnARx Eobertsoj? and Dr. James Rtttherfobd. A BIENNIAL RETROSPECT OF MEDICINE, SURGERY, AND THEIR ALLIED SCIENCES, for the Years 1865 and 186G. Edited by Mr. Power, Dr. Anstie, Mr. Holmes, Dr. B.vrnes, Mr. "NYiKDSOR, and Dr. Hilton Fagge. THE SEVENTH FASCICULUS OF THE ATLAS OF SKIN DISEASES, Comprising original Portraits, illustrating : — Plate XYIII. Moluscum fibrosum sen simplex. Plate XIX. Psoriasis-Lupus (Lupus non exedens, in numerous symmetrical patches). Plate XX. Porrigo contagiosus (e pediculus). ON DISEASES OF THE SKIN, INCLUDING THE EXANTHEMATA. By Professor Hebra. Yol. II. Translated and edited by Dr. Hilton Fagge and Dr. P. Pye Smith. " Had we space, we should have been glad to enter into a lengthened critique of the second volume of Hebra's work. We arc relieved from any misgiving, however, by the fact that the work will be very largely circulated amongst our readers by the Sydenham Societ}-, and that they, witli others who aspire to any real knowledge of skin diseases, would not, under any circimistances, be satisfied without studying the work for themselves. . . . This second volume contains information relative to the most important diseases of the skin ; and it M-ill, we are confident, do good ser- vice in helping on the cause of cutaneous medicine in England." — Lancet, November 7, 1868. LIST OF WORKS ALREADY ISSUED. 87 A TREATISE ON SYPHILIS, HISTORICAL AND PRACTICAL. By Dr. Laxcereatjx, of Paris. Vol. I. Translated by Dr. Whitley. " The work is the most exhaustive book which has been published on the subject, and it has been quoted by all the recent writers of this country, America, and the Continent. As we have intimated, the work is an exhaustive treatise on the subject — a perfect mine of information." — Lancet. A CATALOaUE OF THE PORTRAITS COMPRISED IN THE SOCIETY'S ATLAS OF SKIN DISEASES. Prepared, at the request of the Council, by Mr. Hutchixson". LECTURES ON CLINICAL MEDICINE Delivered at the Eotel-Dieu, Paris, by Professor Tkousseau. Yol. I. Translated, with Notes and Appendices, by the late Dr. Bazike. A TREATISE ON SYPHILIS, HISTORICAL AND PRACTICAL. By Dr. Lancekeatjx, of Paris. Vol. II. Translated by Dr. "Whitley. " Little remains for us to do beyond announcing the appearance of the second — completing the best and most exhaustive book on the subject with which we are acquainted . " — Lancet- LECTURES ON CLINICAL MEDICINE Delivered at the Hotel-Dieu, Paris, by Professor Tkousseaxj. Vol. II. Translated from the third and revised edition of 1868 by Dr. J. Rose CouiiACK. " The work is full of the results of the richest natiu-al observation, and is the pro- duction of one who was enlightened enough to combine with new methods of inves- tigation the vigorous and independent ideas of the old physicians, whom he so eloquently magnilies. The volume is an extremely rich and valuable addition to the library of physicians and practitioners generally." — Lancet. THE EIGHTH FASCICULUS OF THE ATLAS OF PORTRAITS OF SKIN DISEASES, Comprising Life-size Portraits of :— XXI. ERYTHEMA NODOSUM. XXII. MORBUS PEDICULARIS. XXIII. HERPES ZOSTER (with scars of a former attack). A BIENNIAL RETROSPECT OF MEDICINE, SURGERY, AND THEIR ALLIED SCIENCES, for 1867 and 1868. Edited for the Society by Mr. H. Powee, Dr. Anstie, Mr. Holmes, Mr. R. B. Caetek, Dr. B.aknes, and Dr. Thomas Stevenson. 88 THE NEW SYDENHAM SOCIETY. With Portrait, and numerous Lithographic Plates. THE COLLECTED WORKS OF DR. ADDISON. Edited, with Introductory Prefaces to several of the Papers, by Dr. Wiles and Dr. Daldy. " We most cordially commend the decision of the Council of the New Sydenham Society, which led to the publication of this historically interesting and practically valuable book. Few names have, of late years, been better known to the profession than that of the eminent physician whose contributions to its literature, too few in number, have nevertheless been, one and all, highly and justly esteemed. A brief but kindly and discriminating biography of Dr. Addison precedes the collection of his papers." . . . "It is indeed to be regretted that a physician who observed so well, and thought so profoundly as Dr. Addison did, has pubHshcd so little. If, however, we endeavour to weigh the value of what he has left us of matured observa- tion, we can have no hesitation in concluding that his contributions, scanty though they be, oticr a very favourable contrast to many publications of a vastly more pre- tentious character, with which we are, alas I only too familiar." — Edinbnryh Medical Journal, December, 1868. " No one who has studied the valuable papers published by Dr. Addison in the Guy's Hospital Reports, can fail to be pleased that they are now rendered more widely available by this separate publication. His great and extensive knowledge of skin diseases renders the articles on that subject of much interest. If, however, we were asked to select the one most likely to be useful to the practitioner, we should unhesi- tatingly piiint to that on the 'Physical Examination of the Chest.' " — Mtdical Times and Gazette, July i, ISG8. ' ^^^ THE NINTH FASCICULUS OF THE ATLAS OF PORTRAITS OF SKIN DISEASES, Comprising Life-size Portraits of : — XXIY. ERYTHEMA CIPCINATUM. XXY. ECZEMA EllOM SUGAE. XXYI. ACNE YULGAEIS. WORKS IN PREPARATION. Strieker s Manual of Human and Com]iarative Histology. Translated hy Mr. Potvee. (Yol. I. already out.) Wunderliclis Treatise on Temjjeratitre in Disease. Translated Ly Dr. W. B. Voodmax. Trousseau's Lectures on Clinical Medicine. Vol. IV. Tran.slated by Dr. Pvose Cormack. A Biennial Retrospect of Medicine and Surgery for 1869 and 1870. " A Tenth Fasciculus of the Atlas of Portraits of Skin Diseases. Von Troeltsch on Diseases of the Ear. Tran.slated, with Notes, by Mr. Hintox. LIST OF WORKS ALREADY ISSUED. 89 1859. {First Year.) See Page Vol. 1. DiDAT on Infantile Syphilis 78 2. GoocH on Diseases of Women 78 3. Memoies on Diphtheria . . 78 4. Van bek Xoik on the Spinal Cord, etc. . . 78 0. Monographs (Kussmaul and Tenner, Grsefe, Wagner, etc.) 79 1860. {Second Year.) See Page Vol. 6. Dr. Beiqht on Abdominal Tumours 79 7. Feeeichs on Diseases of the Liver, Vol. I. 80 8. A Yeaebook for 1859 80 9. Atias of Portraits of Skin Diseases. (1st Fasci- culus) 80 1861. {Tliird Year.) See Page Vol. 10. A Yearbook for 1860 81 11. Monographs (Czermak, Dusch, Eadicke, etc.) . . 80&81 12. Casper's Forensic Medicine. Vol. I. . . 80 14. Atias of Portraits of Skin Diseases. (2nd Fasci- culus) 82 1862. {Fourth Year.) See Page Vol. 13. Feeeichs on Diseases of the Liver. Vol. II. . . 82 15. A Yearbook for 1861 82 16. Caspee's Forensic Medicine. Vol. II. . . 83 17. Atias of Portraits of Skin Diseases. (3rd Fasci- culus) 82 1863. {Fifth Year.) Sec Page Vol. 18. Kramer on Diseases of the Ear . . 83 19. A Yearbook for 1862 83 20. Neubatjer and Vogei on the Urine 83 1864. {Sixth Year.) See Page Vol. 21. Casper's Forensic Medicine. Vol. III. . . 83 22. Dondees on the Accommodation and Eefractiou of the Eye . . 84 23. A Yearbook for 1863 84 24. AiiAs of Portraits of Skin Diseases. (4th Fasci- culus) . . . . . . . . . . 84 90 THE NEW SYDENHAM SOCIETY. 1865. {Seventh Tear.) See Page Vol. 25. A Yearbook for 1864 84 26. Caspee's Forensic Medicine. Vol. IV. . . 84 27. Atlas of Portraits of Skin Diseases. (5tli Fasci- culus) 85 1866. {Mffhth Year.) See Page Vol, 28. Bernxjiz & GoTTPiL ou Discases of Women. Vol. I. 85 29. Atlas of Portraits of Skin Diseases. (6tli Fasci- culus) 85 30. Hebea on Diseases of the Skin. Vol. I. 85 31. Been^utz & GoupiL on Diseases of Women. Vol. II. 86 1867. (Ninth Year.) See Page Vol. 32. A Biennial Betrospect of Medicine and Surgery 86 33. Geiesingee on Mental Pathology and Therapeutics 86 34. Atlas of Portraits of Skin Diseases. (7th Fasci- culus) 86 35. TRorssEATj's Clinical Medicine. Vol. I. 86 1888. {Tenth Year.) See Page Vol. 36. The Collected Works of Dr. Addison . . 88 37. Hebea on Skin Diseases. Vol. II. 86 38. Lanceeeatjx's Treatise on Syphilis 87 39. Atlas of Portraits of Skin Diseases. (8th Fasci- culus) 87 40. Catalogue of Atlas of Skin Diseases. (First Part) 87 1869. {Eleventh Year.) See Page Vol. 41. Lancereatjx's Treatise on Syphilis. Vol. II. . . 87 42. TEorssEAtj's Clinical Medicine. Vol. II. . . 87 43. A Biennial Betrospect of Medicine and Surgery 87 44. Atlas of Portraits of Skin Diseases. (9th Fasci- culus) . i . . . . . . . . 88 THE NEW SYDENHAM SOCIETY. 91 A THIRD EDITION of the YOLUMES for 1859 has been printed, and also a Second Edition of those for I860. All the Works issued by the Society are now in stock, and can be obtained by New llembers. The Catalogue of the Society's Atlas of Skin Diseases can be had gratis, on forwarding to Mr. Lewis two stamps for postage. CARRIAGE, &c. — The Society's "Works are supplied free of cost to any addi-ess in Loudon, Edinburgh, or Dublin ; but the expenses of carriage to all other places must be borne by the Members to whom they are sent. Members wishing to receive their Volumes by Book- post can do so by pre-paying the postage. Members are rcr[uested to give detailed instructions respecting the mode by which they wish their volumes to be forwarded, and also to remember that the Society's re- sponsibility ceases when the book has been delivered according to the instractions given. Members wishing to receive their works by Book- post can do so by paying the sum of 2«. ^d. for the year. The Subscription is One Guinea annually, to be paid in advance. The best mode of sending money is by post-office order, payable to Mr. Hexrt Kixg Lewis, at the London Office, or by cheque to the order of the Treasurer, Dr. Sedgwick Sauxders. It is requested that in future all communications in reference to the payment of subscriptions, or the issue of books, may be made to Mr. Lewis, the Society's Agent, and not as heretofore to the Secretary. The immediate payment of those subscriptions for the current year which have not as yet leen forwarded, is earnestly reqxiested. JONATHAN HUTCHINSON, 4, FiNSBURY Circus, E.G. Hon. Secretary. Octoher, 1868. "V"' Any Member wishing for additional copies of the Society's Report, &c., can obtain them by applying to Mr. Huxchinsojt, or to the Society's Agent, Mr. Lewis, 136, Gower Street, W.C. The Council will be much obliged by its distribution amongst those thought likely to join the Society. P.S.— The Society's Agent is prepared to supply PORTFOLIOS for the reception of the Plates of Skin Diseases to those Members who may wish for them: — First quality, 10s.; Second quality, 55. Qd. ; Third quality (cloth only), 35. &d. All orders for them must be accompanied by the remittance and instructions as to the mode of transmission. c2 NOTICE TO MEMBEES RELATIYE TO THE PURCHASE OE BACK TOLUMES. It has been decided to offer to the Members of the New Sydenham Society, for a short time, the privilege of purchasing separately certain of the back volumes, of which there is a surplus stock. Of some of these the surplus is very small indeed, whilst of others it is larger, and for this reason the privilege of separate purchase will (in the first in- stance at least) be restricted to Members. Members will, of course, be allowed to purchase for theii- friends, and any one joining the Society for the current year will obtain a Member's rights. The volumes which can be obtained separately are mentioned below, with the price of each. They will be supplied direct by the Agent, Mr. Lewis, and at an uniform postage charge of eightpence per vol. ; or through any of the Society's Local Secretaries. The Society possesses, at the present moment, only 124 complete sets of its publications, and these will, no doubt, soon be sold off. These sets can, under no pretext, be broken, and the volumes now offered for sale are those which are in excess of them. Owing to the varying number of Members and other causes, the accumulation has been somewhat irregular, and for certain years a considerably larger number remains in hand than for othei's. As very large editions have now been issued, it is in the highest de- gree improbable that any of the Society's works will ever be reprinted, and the opportunity of obtaining a complete set must, therefore, soon cease. The price of a set (compiising 35 volumes and 9 fasciculi of the Atlas of Skin Diseases), is eleven guineas. New Members can be enrolled oa sending their names and subscrip- tions to Mr. Lewis, the Society's Agent, 136, Gower Street; or to any of the Society's Local Secretaries. LIST OF SURPLUS VOLUMES, WITH PRICES. Atlas of Skin Diseases. Fasciculi I. to VIII. 31. os, or sepa- rately, 10s 6d each. On St/philis in Infants. By Paul Diday. Translated by Dr. "NYhitlet. 4s Qd Goocli on the more Important Diseases of Women and Children. Prefatory Essay by Dr. Robert FERGUSo^^ Woodcuts. 45 Qd Memoirs on Diphtheria. By Bretonneau, Trousseau, Daviot, Guersant, Bouchut, Empis, &c. Selected and Translated by Dr. R. H. Semple. 55 On the Minute Structure and Functions of the Spinal Cord. By Prof. SCHR(EDER VAN DER KoLK. And On the Minute Structure and Functions of the Medulla Oblongata, and on the Proximate Cause and Rational Treatment of Epilepsy. By Prof. ScHRCEDER VAN DER KoLK. Translated by Dr. W. D. Moore, of Dublin. In one volume ; with numerous Lithographs. 6s LIST OF SURPLUS VOLUMES. 93 Experimental Researches on the Effects of the Loss of Blood in inJA'xing Convulsions. By Dis. Kussmaul and Texner. Translated by Dr. Bronneb, of Bradford. On tlie Process of Repair after Resection and Extirpation of Bones. By Dr. A. Wagner, of Berlin. Translated by Mr. T. Holmes. Nume- rous Woodcuts. Professor von Grcefe's Three Memoirs on Glaucoma, and on Iri- dectomii as a Means of Treatment. Translated by Mr. T. Windsor, of Manchester. Three Monographs in one volume. 5s Memoirs on Abdominal Tumours and Intumescence. By Dr. Bright. Reprinted from the Guy's Hospital Reports, with a Preface by Dr. Barlow. Numerous Wuodcuts. 6s A Clinical Account of Diseases of the Liver. By Professor Fbekichs. Translated by Dr. Murchisok. Numerous Woodcuts and coloured Lithographs. 2 vols. 12s 6d Czermah on the P^xictical Uses of the Laryngoscope. Translated by Dr. G. D. Gibb. Numerous Woodcuts. Dusch on Thrombosis of the Cerebral Sinuses. Translated by Dr. Whitley. Schroeder van cler Kolk on Atrophy of the Bimn. Translated by Dr. W. Moore, of Dublin. Four Lithographs. Radicke^s Papers on the Appliccdioji of Statistics to Medical En- quiries. Translated by Dr. Bonp. Esmarch on the Uses of Cold in Surgical Practice. Translated by Dr. Montgomery. The above Five Monographs in one vol. 5s A Handbook of the Practice of Forensic Medicine, Based upon Personal Experience. By J. L. Casper, ]\I.D., Professor of Forensic Medicine in the University of Berlin. Translated by Dr. G. W. Balfour. Vols. II. III. IV. 75 U each. The Aural Surgery of the Present Day. By W. KraMER, M.D., of Berlin. Translated by Henry Power, F.R.C.S., M.B. With two Tables and nine Woodcuts. 3s Qd A Guide to the Qualitative and Quantitative Ancdysis of the Urine. By Dr. C. Neubauer and Dr. J. Vogel. Fourth edition, considerably enlarged. Translated by "W. 0. Markham, F.R.C.P.L. With four Lithographs and numerous Woodcuts. 6s On the Anomcdies of Accommodation and Refraction of the Eye, with a Preliminary Essay on Physiological Dioptrics. By F. C. Donders, M.D., Professor of Physiology and Ophthalmology in the University of Utrecht. Translated from the Author's Manuscript, by W. D. jNIoore, M.D. 10s U Trousseau's Clinical Medicine. Vols. I. and 11. , 10s Qd each. Yearbook of Medicine and Surgery. 1859-66, seven vols. 2>bs. And of Towns where it is desired that an appointment should be made. The Council will he much obliged to any gentlemen tcilling to act as Local Secretaries in towns tchere the appointment is vacant, if they iciU communicate icith Mk. Hutchinson. Any suggestions of suitable names will also confer a favour. The duties of Local Secretaries consist in arranging for the distribution of books, the collection of Subscript inns, and canvassing for new members. Banbury Bangor Barnsley Barnstaple Bath Batley, Yorkshire Beaumaris, Anglesea Beccles Bedford Bedlington . Beverley Bewdley , Bideford Paulin Martin, Esq. Morris Jones, Esq. England and Wales. Aberdare Abergavenny Abingdon . Aberystwith Accrington . Acton Alfreton Alnvrick Altrincham , Ampthill . Andover Arundel Ashbourne . Asliford Ashton-under-Lyne Atherstone (Warwick) Aylesbury Bacup C. Evershcd, Esq. Robert Ceely, Esq. E. Whitaker, Esq., M.B. H. R. Hughes, Esq. R. Budd, Esq., M.D. J. K. Spender, Esq., M.D. W. E. Crowfoot, Esq. W. H. Stretton, Esq. J. Gabb, Esq. LIST OF HON. LOCAL SECKETARIES. 95 Bilston Birkenhead. . Birmingham Bishop Aacklancl Bishop's Stortford Blackburn . , Blackpool . . Bodmin Boroughbridge Boston, Lincolnshire Bradford, Yorkshire Brecon Brentwood Bridgend Bridgenorth Bridgewater Bridlington Bridport Brighton Bristol Brixham, Devon , Bromley, Kent Brompton, Kent Buntingford, Herts Burnley, Lancashire Burton-on-Trent . . Bury, Lancashire . . Bury St. Edmunds. . Buxton, Derbyshire Cambridge . . Canterbury . . Cardiff Carlisle Carmarthen Carnarvon . . Chard .. _ .. Cheadle, Cheshire . . Cheadle, Staffordshire Chelmsford . . Cheltenham Chertsey Chepstow . . Chester Chesterfield Chichester . . Chippenham, "Wilts Chorley, Lancashire Christchurch Cirencester . . Colchester . . George Walker, M.D. John Waterson, Esq. Thos. B. Thwaites, Esq. Matthew J. Rae, M.D. A. Mercer Adam, M.D. J. E. Leeson, M.D. Prestwood Lucas, M.D. J. C. Quennell, Esq. W. Thursfield, Esq. W. L. Winterbotham, Esq., M.D. C. E. Hutchinson, M.D. J. S. Webb, Esq. Charles J. Beard, M.D. G. E. A'tchley, M.B. H. S. Hughes, Esq. W. M. Coultate, Esq. G. Lowe, Esq., M.D. H. R. Harris, Esq. W. E. Image, Esq. E. Carver, M.B. James Eeid, Esq. W. B. Page, Esq. Thomas Lewis, M.D. E. "W. Spicer, Esq. E. T. Wilson, M.D, T. King, Esq. W. McEwen, M.D. C. Black, M.D. N. Tyacke, M.D. E. Waylen, Esq. 96 THE KEW SYDENHAM SOCIETY. Colney Hatch Congleton Coventry Cowes, Isle of Wight Crewe Croydon Darlington Dartford Deal, Kent Denbigh Deptford Derby Devizes Devonport Dewsbury Diss, . Doncaster Dorchester Dorking Douglas, Isle of Man Dover Droitwich Dudley Durham Ealing Eastbourne East Grinstead East Retford Edmonton . . Ely . . Enfield Epsom Exeter Exmouth . . Ealmouth . . Eaversham . . Folkestone . . Erome Gainsborough Gateshead . . Gloucester . . Godalming . . Gosport Grantham . . Gravesend . . Great Grimsby Great Malvern Greenwich and Blackheath Guernsey Guildford E. Waters, M.D. J. Atkinson, Esq. A. Carpenter, M.D. W. H. Morris, Esq. George T. Jones, Esq. H. Goode, M.D. G. Waylen, Esq. H. Ward, Esq. J. Sykes, M.D. G. Curme, Esq. S. S. Roden, M.D. J. Goodchild, Esq. B. Roberts, Esq. W. B. Pritchard, Esq. J. Muriel, Esq. B. Godfrey, M.D. T. Lyle, M.D. E.. Richardson, M.D. T. Stokes Guppy, M.D. R. L. Bowles, M.D. E. Bush, Esq. D. Mackinder, M.D. R. Shipman, Esq. J. Armstrong, M.D. R. H. Bradley, M.D. , , T. J. Sells, Esq. 1 LIST OF HON. LOCAL SECRETARIES. 97 Halifax Hanley Hanwell Harlo'sr Harrow gate Harro w-on-the-Hill Hartlepool . . Hastings Haverfordwest Hemel-Hempstead Hereford Hertford Hexham High Wycomhe Hillingdon . . Hinckley, Leicestershire Hitchin Hounslow . . Holywell . . Huddersfield Hull Huntingdon Hyde Ilfracomhe . , Ipswich Isleworth . . Jersey Kendal Kenilworth. . Kettering . . Kidderminster Kingshridge Kingston-upon-Thames Knottingley Lancaster Langport Launceston Leamington Ledbury Leeds Leek Leicester Leominster Lewes Lichfield Lincoln Liskeard Liverpool Llandilo Llandovery R. N. Day, Esq. J. Underwood, M.D. J. D. Brown, M.D. Thomas Turner, Esq. E. E. ShiUitoe, Esq. J. C. Davies, M.D. Kelburne King, M.D. Michael Eoster, Esq. C. W. Hammond, M.D. C. Yaudin, M.D. W. Eoden, M.D. John Elliot, Esq. W. W. Kershaw, M.D. J. Prankerd, Esq. T. Ebbage, Esq. M. A. Wood, Esq. C. J. Wright, Esq. E. Cooper, Esq. J. Barclay, M.D. Samuel Barnett, Esq. C. E. E. Wclchman, M.D. T. Sympson, Esq. J. Burrows, M.D. , , D. Thomas, Esq. 98 THE NEW SYDENHAM SOCIETY. Llandudno . . Llanelly Lomington . . Longton, Staffordshii'e Loutli Lowestoft . . Ludlow Lutou Lutterworth Lynn Macclesfield Maidenhead Maidstone . . Maldon, Essex Malton Malvern Manchester . . Mansfield . . Market Drayton Marlborough, "Wilts Merthyr Tydvil Middleshoro' -on-Tees Mirfield Mold Monmouth . . Morpeth Newark-upon-Trent Newbury, Berks Newcastle-under-Lyno Newcastle-upon-Tyne ISTew Malton, Yorkshire . . Newmarket, Cambridgeshire Newport, Hants Newport, Mon. Newton Abbot Northampton North Shields Northwich . . Norwich Nottingham Odiham Oldham Oswestry . . Otley Oxford Penrith Penzance Peterborough Peterefield . . Plymouth . . B. Thomas, Esq. ^Y. H. Clubbe, Esq. Dr. Woakes. E. "Woodward, Esq. E. Fry, Esq. J. J. Wright, M.D. ^y. C. West, M.D. H. Simpson, M.D. J. Richardson, Esq. . T. Prosser, Esq. , J. Bunny, M.D. ! G. H. PhHipson, M.D. ! W. "W. Morgan, M.D. . Charles Jewel Evans, Esq. . Eobert Peart, M.D. . Haynes Eobinson, Esq. . W. H. Eansom, Esq. . J. M'Intyre, M.D. . T. Piatt, Esq. J. B. Montgomery, M.D. G. T. Southam, M.D. Connell "Whipple, Esq. LIST OF HON. LOCAL SECRETARIES. 99 Poole Pontefract Pontypool Portsmouth Preston Putney Eamsgate and Isle of Thanet Eeading Eedruth Eeigate Eichmond, Surrey Eipon Eochdale Eochester and for Chatham and Strood Eochford Eomford, Essex Eoss Eotheram . . Eugby Eugely Eyde, Isle of Wight Eye, Susses Saffron Walden St. Alban's . . St. Austell . . St. Helen's, Lancashire St. Ives Salisbury . . Scarborough Shaftesbury Sheerness . . Sheffield Shepton Mallet Sherborne . . Shirley, Hants Shrewsbury Sidmouth Skipton Sleaford Smethwick Snaith Southampton Southmolton Southport . . South Shields Spalding Stafford Stalybridge. . Stamford . . E. Allen, Esq. T. L. AValford, Esq. J. S. Hichens, Esq. A. K. Maybury, M.D. T. Collier, Esq. Frederick J. Brown, M.D. T. King, Esq. W. S. Eootes, M.D. E. J. Shearman, M.D. E. Adamson, M.D. H. Stear, Esq. E. P. Twyford, M.D. W. D. Wilkes, Esq. E. B. Cooke, Esq. E. Swales, Esq. M. M. de Bartolome, il.D. Horace Nutt, Esq. E. Andi-ew, M.D. J. J. Mackenzie, M.D. E. W. Griffin, M.D. L. Armstrong, Esq. T. Cammack, M.D. S. Cookson, M.D. W. Newman, M.D. 100 THE NEW SYDENHAM SOCIETY. Stockport . . Stockton-on-Tees . . Stoke-on-Trent Stourbridge Stratford, Essex Stratford-on-Avon , . Stroud, Gloucestershire Sunderland , Surbiton Swansea Swindon Sydenham Taunton Tavistock Teign mouth Tenby Tewkesbury Thetford Thirsk Tiverton Torquay Totnes Tottenham Truro Tunbridge Tunbridge Wells . . Twickenham Ulverston . . Uxbridge . . Ventnor Waketield Wallingford Walsall Warminster Warrington Warwick , . Watford Wednesbuiy Wellington, Somerset Wellington, Salop . . Wells Welshpool, Montgomeryshire Wem West BromAvich Weston-Super-Mare Weymouth . . Whitby Whitehaven Wigan Wimbledon. . J. D. Bii'd, M.B. W. H. Oliver, M.D. J. J. Nason, M.B. M. Douglas, Esq. G. M. Swinhoe, Esq. E. A. Stutter, M.D. W. Liddon, M.B. W. C. Lake, M.D. W. H. Eyott, M.D. P. P. Nind, Esq. E. H. May, M.D. A. Paull, Esq. J. Milner Barry, M.D, G. H. Macnamara. J. B. Martin, Esq. Dyson Wood, Esq. C. A. Barrett, Esq. A. AVyllie, M.D. C. Bleeck, Esq. C. C. Madden-Medlicott, M.D. S. B. Gwynne, Esq. J. Mauley, Esq. E. Alford, Esq. F. C. G. Griffin, M.D. J. Dowson, M.D. J. E. I' Anson, M.D. G. Love, Esq. LIST OF HON. LOCAL SECRETAEIES. 101 'Wimborne , . "Winchester . . "Windsor "WirksTVorth Wisbeach . . Witney Wolverhampton "Woodbridge "Woodford "Woolwich Worcester Worksop Worthing Wrexham Tarmoutli Yeovil York Aberdeen . . Ayr . . Banff Berwick-on-Tweed Brechin Dumfries Dundee Dunfermline Edinburgh . . Elgin Eorfar Glasgow Greenock Haddington Hamilton . . Helensburgh Inverness . . Kilmarnock Leith Lerwick (Shetland) Linlithgow . . Montrose Paisley Peebles Perth Bothesay St. Andrew's, Fife Stirling Thurso Wishawtown F. J. Butler, M.D. E. Bower, M.D. P. Fawssett, M.D. A. Batt, M.D. V. Jackson, Esq. J. S. Bunce, Esq. R. Mason, Esq. W. J. Harris, Esq. T. T. Griffith, Esq. C. Palmer, Esq. W. W. Westcott, Esq., 3Iartook G. Shann, M.D. Scotland- John Wight, M.D. J. Barclay, M.D. M. J. Tm-nbull, M.D. P. Murray, M.D. W. F. Murray, Esq. (Books per Mr. Winter). W. Husband, M.D. G. Duff, M.D. D. Dewar, M.D. James Wallace, M.D. T. Howden, junr., M.D. R. A. Manford, M.D. James Struthers, M..D. P. D. Loeterbagh. G. D. Baird, M.D. James C. Howden, M.D. W. McKechnie, M.D. John Connel, M.D. W. Stii'ling, M.D. 0. H. Bell, M.D. Charles GibsoU; M.D. 102 THE NEW SYDENHAM SOCIETY. Ardee Armagh Ballinasloe Belfast Carlow Carrick-on-Suir Cashel Cavan Clonmel Cork Dublin Dundalk Ennis Enniskillen . Gal-svay Kilkenny Kingstown Lifford Limerick Lctterkenny Lisbiirn, Antrim Listo-wcl Londonderry jilallow Moatc MuUingar Nenagh 'New Eoss Nevny Parsonstown Queenstown Koscommon Rothmines Eoscrea Sligo Thurlcs Tralce Tiillamore Waterford Westport "Wexford Youghall Ireland. Thomas J. Moore, M.D. Thomas Cuming, M.D. H. Whitaker, M.D. J. Martin, M.D. W. Malcolmson, M.D. E. Finn, M.D. "W. D. Moore, M.D. W. O'Brien Adams, M.D. R Little, M.B. T. Kane, M.D. H. Thorp, M.D. AV. Bernard, M.D. W. J. Gahvey, M.D. J. Harrison, M.D. G. Mackcsy, M.D. H. H. Boxwell, M.D. Paris. In Paris list twenty-three Members. J. Giialdes, M.D. LIST OF HON. LOCAL SECRETABIES. 103 Calcutta Madras Bombay Lahore Adelaide Melbourne Sydney Nelson Montreal Amsterdam. J. ^Y. E. THanus, M.D. India. . . Messrs. Bathgate and Co. . . W. N. Chipperfield, Esq. . . F. G. Joynt, M.D. . . Burton Brown, M.D. S. Australia. . . A. WhitteU, M.D. Victoria. . . Edward Barker, Esq., M.D. New South Wales. New Zealand. Canada. New York . , Boston Philadelphia Baltimore . United States. Dr. Bumstead (Messrs. "Wood and Co.). B. H. Salter, M.D. Eichard J. Dungiisou, M.D. (Messrs. Lindsay and Blakiston.) Barbadoes. Eobert E. Walcott, M.D. Demerara. Stephen Scott, M.D. 104 THE NEW SYDENHAM SOCIETY. Port of Spain. Dr. Bakewell. General Secretary {Hon.). JONATHAN HUTCHINSON, Esq., 4, Finsbury Circus, Londou. Agency and Bepdt for Books. Mr. H. K. LEWIS, 136, Gower Street. LIST OF THE OFFICERS AND MEMBERS OF THE NEW SYDENHAM SOCIETY. JULY, 1870. John Hilton, Esq., F.E.S. Wia-''$x-mhtnU* Heset W. Acland, M.D., F.R.S., Oxford Thomas E. Beattt, M.D., F.R.S. Ed., Dublin James R. Bennett, M.D. Charles Chad wick, M.D., Zeecls SiK Dominic Cobeigan, M.D., Bart., BuUin Edward Charlton, M.D., I{eivcastle Samuel Hey, Esq., Leeds James Paget, Esq., E.R.S. W. D. Husband, Yorlc W. D. Moore, ]\[.D., Dullin G. E. Paget, M.D., Camlridge Thomas B. Peacock, M.D. Francis Sibson, M.D., F.R.S. Sir J. Y. Simpson, M.D., D.C.S., Bart, {deceased) Sir Thomas "W^atson, M.D., F.E.S., Bart. C. J. B. Williams, M.D., F.R.S. Erasmus Wilson, Esq., F.R.S. d lOG OFFICERS. James Andhew, M.D. Pkakcis E. Anstie, M.D. John Baeclay, M.D., Leicester WAEBUEToif Begbie, M.D., Edin- burgh Charles Brooke, Esq., E.E.S. Thomas Cammack, M.D., Spalding Thoatas M. Daldy, M.D. Herbert Daties, M.D. J. Langdon H. Doivn, M.D. Robert Drtjitt, M.D. A. E. Durham, Esq. C. HiLToi^^ Fagge, M.D. R. "WiLBRAHAM FaLCONEK, M.D., Bath Samuel Fexwick, M.D. T. Bell Fletcher, M.D., £ir- mingham E. C. FuRNER, Esq., Brighton Christopher Heath, Esq. M. H. Higginbottom, Esq., Not- tingham J. Hughlings Jackson, M.D. T. Carr Jackson, Esq. J. C. Langmore, M.B. Arthur Leared, B.A., M.D., M.R.I.A. G. May, Esq., Reading J. W. Ogle, M.D. Oliver Pemberton, Esq., Bir- mingham "W. Roberts, M.D,, Manchester George Shann, M.D., Yorh Septimus "W. Sibley, Esq. A. P. Stewart, M.D. William Turner, M.B., F.R.S.E., Edinburgh Hermann "Webeb, M.D. "W. Sedgwick Saunders, M.D., 13, Queen Street, Cheapside, E.G. J. S. Bristowe, M.D, I Thomas Bryant, Esq. Andrew Clark, M.D. Jonathan Hutchinson, Esq., 4, Finsbury Circus, E.C. Me. H, K. Lewis, 136, Gower Street, W.C. imibm. Abeeda.ee Jones, Evan, Tymaivr Abeegavenny Chapman, T. Algernon, M.D. Steel, S. H., M.D. Abeetstwith Jones, Moebis, Loc. Sec. Abingdon , Majitin, Paulin, Loc. Sec. Acton see Ealing Aigburth. see Liverpool Aldeeshot Aldershot Medical Book Club Alfoed Handsley, Thomas A. Alconbuiy Hill see Huntingdon Alresford see "Winchester Alton see Odiham Ardwick see Manchester Aeundel Eveeshed, C. S., Loc. Sec. Ashcott see Bridgwater AYlESBtTEY CeELT, E.OBEET, LoC. SeC. Hooper, Charles, Ayleshury Humphry, J., Stone Asylwn Lee, Richard, Thame Morris, Henry Webster, F. E., St. Allan's Bactjp "Whitakee, E., M.B., Loc. Sec. Bampton Atkinson, J. P., M.D. Banbuey Hyde, "W. Wellington, Bloxham Dewar, James, M.D. Bangoe Williams, W. Baeking McDonald, M.D. Baenet Livingstone, J. Baenstaple BuDD, E.., M.D., Loc. Sec. Barnstaple Medical Book Club Harper, Joseph Baeeow-in-Fxjeness Stark, P. W., M.D. Bai'ton Hill see Bristol Basingstoke see Odiham Baslow see Sheffield Bath , , Spendee, J. K., M.D., Loc. Sec. Church, J. N. Davies, W., M.D. d2 108 MEMBEES, Bath, continued Falconer, Eandle W., M.D. Fowler, R. S., Behnoyit Goodridge, H. T. A., M.D. Harries, C. A. Hensley, Henry, M.D. Lawrence, J. Mason, F. Michael, D. StockweU, T. G. Stone, R. iN". Tayler, C, Troivhridge Beaminster see Bridport Bcbington see Chester Beccles Ceowfoot, W. E., Loo. Sec. Metcalf, E. J., M.D. Beckenham see Sydenham Bedford Coombs, R. H., M.D. Bedlington Carmichael, D. Bellingham Sutherland, W. Belper Gaylor, E., L.R.C.P. Benenden Pinyon, P. Bennington see Boston Ben Rhydding see Otley Bethesda Hughes, H., Loc. Sec. Beverley Stretton, W. H., Loc. Sec. Bewdley Gabr, John, Loc. Sec. Grcensill, J. N., Great JVitley Jones, W. W., Cleohury-Mortimer Bexhill see Hastings Bidefobd AcKLAND, AY. H., M.D., Loc. Sec. Bildeston see Brentwood Billericay see Brentwood Billesdon see Leicester Birkenhead Walker, George, M.D., Loc. Sec. BowcD, Essex, M.D. Braidwood, P. M., M.D. Byerley, Isaac, Seacomhe Forbes, David Gibson, A. C. Godden, Joseph Spratly, Samuel, M.D., Rochferry Birmingham: Waterson, John, Loc. Sec. Archer, John, Edghaston Baker, Alfred Bassett, John Berry, Samuel Borough of Birmingham Central Free Library MEMBERS. 109 BiEMiNGHAM, confiuucd , . Davis, H. Drummond, A. Evans, G. F., M.D. Fleming, Alexander, M.D. Fletcher, T. B. E., M.D. Gamgee, J". S. Goodall, W. P. Hadley, J. J. Hicks, Charles, Smethwich Howkins, T. Jones, George Key worth, J. W., M.D. Marshall, G. H., M.D. Medical Book Society : G. Jones, Sec. Medical and Chirurgical Society: T. W. Williams, Sec. Midland Institute : J. Mackay, Sec. Pemberton, Oliver Russell, James, M.D. Rutherford, J., M.D., Asylum Schofield, W. J., Jligkgate Smith, R. "VY., Harhorne Birtley see Newcastle-upon-Tyne Bisnop Auckland Thwaites, Thomas B., Loc. Sec. Hutchinson, Y. Jobson, J. Mackintosh, Coundon Bishopwearmouth see Sunderland BiTTjEENE Parkcs, E. A., M.D. BiACKBUEN Rae, Mattiiew J., M.D., Loc. Sec. Cootes, W., M.D. Curran, W., M.D. Davidson, M.D. Gillibrand, W. Scaife, J. Blackheath Beadley, R. H., M.D., Loc. Sec. Burton, J. Burton, J. M. King, Osmer. Noyes, H. G., M.D. Pope, A. C, M.D. Purvis, P., M.D. Roper, A. Rookc, H. T., M.D., The Dreadnought Steel, C, Leivisham Shute, Gay BiACKrooL Morris, C. H., M.D. 110 MEMBERS. Blandford see Dorchester Bletchingley Leslie, W. A. Blofield see Norwich Bloxham see Banbury Bolton Whittle, W. Bootle see Liverpool BoROTJGHBBiDGE Sedgwick, James Boston Adam, A, Meecee, M.D., Loc. Sec. Atkinson, F. H., Levertoyi Grantham, T. P., M.R.C.P., Biirgh-le- Marsh Lamphier, R., M.D., Alford Pilcher, W. J. Smith, J., M.D., Wrangle Snaith, F., M.D. Walker, J. W., M.B., Spilsly Botesdale see Diss BoTJENEMouTH Falls, "VV. S., M.D. BowDON Arkwright, J. Bracebobottgh Willis, F., M.D. Box see Chippenham Bradford, YoRKsniRE , . Leeson, J. F., M.D., Loc. Sec. Brown, S., M.D. Foster, J". Hamilton, R. Lodge, S. Miall, Philip Rouch, J. R. Spencer, Herbert Bradpord-on-Aton Adye, W., M.D. Braintree Harrison, John Brampton Thorn, Alexander, M.D. Brecon Ltjcas, Peestwood, M.D., Loc. Sec. Jones, Talfourd, M.D. North, John Williams, James Williams, T. Edward, Talgarth Brentford Earle, E. S. Brentwood Qxjennell, J. Cooper, Loc. Sec. Growse, J. L., Bildeston, Suffolk Growse, R. Bridgnorth Thttrsfield, W., Loc. Sec. Downes, T. R. C., Munslow Mathias, Alfred Proctor, John W., Shiffnall Thursfield, T. G., Brosehj MEMBERS. Ill Beidgwatek 'WiNTEEBOTHAin, W. L., M.D., Loc. Sec. Axford, W. H., M.B. Carse, E., M.D., Weston- Zotjland Cornwall, J., Ashcott Farmer, F., M.D. Parsons, J. Beidiingion HuTCHXNSOK, C. F., M.D., Loc. Sec. Dawson, C. W., Ilunmmiby Savile, R., M.D., Nafferton Beidpoet "Webb, J. S., Loc. Sec, Bemninster Broster, B. "W"., Beaminster Daniels, J. "W., Beaminster Denziloe, Matthew Hay, W. H. Beighton , Beaed, Chaeles J., M.D., Loc. Sec. Barker, S., M.D. Furncr, E. J. Humphrey, Frederick A. Library of the Medical Society Moon, Henry, M.D. Oldham, J. Bichards, David Eogers, E. J. Stephens, J., M.D. Sussex County Hospital Tuke, J. K. Watts, W. H., M.D. Beigg Moxon, J. B. Brislington see Bristol Beistol Atchley, G. F., M.B., Loc. Sec, Gotham Beddoe, John, M.D. Clifton Board, E. Bolton, David, Clifton Brittain, F., M.D., Clifton Bristol Medical Library Bristol General Hospital Library Burleigh, A., Cotham Clark, Michell, Clifton Clark, Thomas, Clifton Coe, R. W. Collings, C, Cheiv-Magna Crossman, Edward, Hamhrook Davies, David Day, W. E., Barton Hill Dew, Heniy, Fensford Fendick, R. 112 MEMBEKS. BuiSToL, continued Fislier, E,., Cothain Fox, E. L., M.D., Clifton Pox, Charles Henry, M.D., Brislington Fripp, Heury, M.D., Clifton Gourlay, F., M.D., Weston-super-Mare Green, Thomas Hore, Henry Lansdown, Joseph G. Leonard, Crosby, Clifton Lounds, T. M., M.D., Pensford Lyon, Gilbert, M.D., Clifton Marshall, Henry, M.D., Clifton Ormerod, Henry, Westhury-on-Triin Prichard, Augustine, Clifton Royal Infirmary Library Sheppard, W. Sleeman, Philip, Clifton Smerdon, Charles, Clifton Smith, W., Clifton Swete, Horace, Wrington Symonds, John A., M.D., Clifton Wine, Henry Broadmoou Orange, W., M.D. Maddox, W. G. Beomley Hughes, H. S., Loc. Sec. Ilott, James "W. "Williams, E. A. Beomsge,ote Batten, W. S. Brosely see Bridgnorth Buckingham see Aylesbury Bures see Colchester Burgh-le-Marsh see Boston BuiLTH Bennett, Hugh BUEKLEY CotJLTATE, W. MiLLER, LoC. SeC. Briggs, Henry, M.D. Brumwell, J. C, M.D. Dean, T., M.D. Utley, Hiram Burntwood see Lichfield Burscough see Ormskirk BuESLEM Walker, Joseph, for North Stafford In- firmary Bueton-on-Teent Lowe, Geoege, M.D., Loc. Sec. Mason, P. B. Burwell see Ely BuEY Haeeis, H. p., Loc. Sec. BuEY St. Edmtjnds Image, W. E., Loc. Sec. MEMBERS. 113 Cambeidge Carter, Edmund, M.B., Loc. Sec. Bradbury, J. B., M.D. Carver, E. J., Melbourn Chance, F., M.B. Drosier, W. H., M.D. Grove, E. W., M.D., St. Ives HaU, F. Eussell Newton, Lawrence J. Paget, J. E., M.D. Pinchard, Benjamin, Cottenham Pyne, R., Royston Ransom, Robert, M.D. Canteebuey Reid, James, Loc. Sec. Kersey, R. C., M.D., Littlehourne Sadler, H. S. Tuckey, C. C, M.D. Capel see Dorking Caediff Fiddian, A. P., M.D. Sheen, A., M.D. Carlisle Page, W. B., Loc. Sec. Arras, "W. Brown, Robert Campbell, J. A., M.D. Carlyle, D., M.D. Elliott, Robert, M.D. Lockic, Stewart, M.D. Reeves, "W". Caemarthen Lewis, Thomas, M.D., Loc. Sec. Brigstock, C. A. Davies, Evan Parry, Asylum Hughes, John, F.R.C.S. Rowlands, James, F.R.C.S. Castleeord Kempe, E. AV"., Loc. Sec. Horner, E. Castletoi^, Derbt Winterbotham, John Catteeick Cockcroft, William Caxton see Cambridge Cerne- Abbas Ewcns, John Chard Spicer, R. W., Loc. Sec. Marshall, T. H. Spicer, Northcote AV. Charmouth Norris, Henry E. Chapelton see Sheffield Chapel-en-Frith see Buxton Charlton see Manchester Chatham see Rochester 114 MEMBERS. Cheltenham Wilson, E. T., M.D., Loc. Sec. Askwith, K., M.D. Bubb, T. Ker, C. D., M.D. Kilgour, J. S., M.D. Newman, K., Cheltenham Medical So- ciety Thorpe, Disney, M.D, Winterbotham, Lauriston Chepstow King, Thomas, Loc. Sec. Audland, J., Tintern Parva Cheetsey Shurlock, Mainwaring Cheshunt see Enfield Chester McEwen, "W., M.D., Loc. Sec. Brierley, T. B., Tattenhall Davies-Colleys, Thomas, M.D. Dobie, "W. M., M.D. Harrison, John, Jun. Henderson, C, M.D. Hill, George, M.D., Hooton Elms Hughes, E. T., M.D., Mold Infirmary Library Jephcott, L. J., M.D. Moreton, J. E., Tarvin Eoberts, J., M.D. Eussell, D., M.D., Neston Taylor, J., L.R.C.P. Lond. Theed, F., Rhyl Thelwall, W., Farndon Waters, Ed., M.D. Weaver, — , M.D., Froodham Williams, W., M.D., Mold Chesteefield Black, C, M.D., Loc. Sec. Booth, Charles, M.D. Eoulds, S. Hart, C. G. B. Eobinson, Henry Rose, J., M.A., M.D., R.N., Hospital Walker, B. Chester4e-Street see Newcastle-upon-Tyne Chew-Magna see Bristol Chichesxek Tyache, N., M.D., Loc, Sec. Buckell, L., M.D. Caffin, W. C. Ereeland, Frederick Leech, Edw. MEMBERS. 115 Chippinham Crisp, James, Lacock King, Jasper, Melk&ham Snow, T. F., Box Chipping Noetok Hopgood, Thomas Choklet Paterson, W., M.D. Chijdleigh , Lillies, G. "W"., M.D. CrNDERFOED Whatmough, Charles, M.D. CiREKCESTER Hodges, W., M.B. Taylor, Theodore Cleator see Whitehaven Cleckheaton &ee Bradford Clevedojj" Davis, T., M.D. Clcobury-Mortimer see Bewdley Clifton see Bristol CocKEEMOiTTH Dodgson, H., M.D. CoGGLESHALL Giles, Harold Colchester . . . . , "Waylen, E., Loc. Sec. Bree, C. R., M.D. Fenn, T. H., JS^at/land Morris, David P. Salter, J. H., Tolleshunt D^Arcy WaUace, A., M.D. Coleshiil see Birmingham Collingham see Nevrark-on-Trent Colkey-Hatch ........ Marshall, "W. G. Corbrtdge , McLean, Hugh, M.D. Corsham see Chippenham Cotham see Bristol Cottenham see Cambridge Coundon see Bishop Auckland Coventry "Waters, E., M.D., Loc. Sec. CowEs Hoffmeistcr, W. C, M.D. CowFOLD Graveley, T. Crewe Atkinson, J., Loc. Sec. Croydon Carpenter, Alfred, M.D., Loc. Sec. Cleaver, H. A. Lanchester, Henry, M.D. Tompkins, C. P., Beddington Ctjlcheth Sephtou, R., M.D. Darlington Morris, W. H., M.D., Loc. Sec. Cockcroft, George, Htcnvorth-on-Tees Cosser, T., M.D., Hunoorih-on-Tees Fothergill, John R. Jackson, T. H., M.D. Mackie, James, KeigMngton Piper, D. E. Dartmouth see Kingsbridge 116 MEMBERS. Dawlet Geeen Soame, C. B. H. Dawlish see Teignmouth Deal Hulke, F. J., M.B. Lond., Loc. Sec. Davey, R. Staines, M.D., Walmer Mercer, Thomas Denbigh Jones, G. T., Loc. Sec. Deptfokd , Cope, Eicardo Grigor, J., M.D. Derby Goode, Heney, M.D., Loc. Sec. Baker, J. W. Fearn, S. "W. Gentles, T. L. Hitchman, J., M.D. Iliffe, Frank Ogle, W., M.D. Tasker, Eichard T., Melbourne Devizes Waylen, Geoege, Loc. Sec. Bodaian, F. H. Carter, C. H., M.D., Peivsey Hitchcock, Chas., M.D., Market Lavington Marston, C. H., M.D. Devonport see Plymouth Diss Ward, Henry, Loc. See. Amyott, Thomas E. Gooch, .T. "W., Stradbroke Dolgelly Jones, Edward, M.D. Doncastee Sykes, John, M.D., Loc. Sec. Clarke, Thomas Kenyon, J., Hooton Pagnell Kiernan, Laurence Lister, John Phillips, G. G., Tickhill Stone, E., M.D., South Elmshall Storrs, llobert Dorchester Curme, George, Loc. Sec. Bacot, W. G., Blandford County Hospital Medical Library Clapcott, J., Ever shot Emson, Alfred Evans, G. M., Bridport Good, J. Panton, G. Dorking Chaldecott, C. W. Jardine, J. L., Capel Dover Astley, E. F., M.D. MEMBERS. 117 Downham Market see Ely Dkoitwich EoDEN, S. S., M.D., Loc. Sec. Bennett, F. J., M.D. Dronfield see Chester and Sheffield Drouwy Llanfachreth see Holyhead Droylsden see Manchester DuHHAM Jepson, E. C. Ealing Goodchild, John, Loc. Sec. Brown, G. D. Lingham, H. B., Actoti Earl's Shilton see Leicester Eastbouene EoBEETS, Bransbt, Loc. Sec. East Molesey Skimming, E. East Eainton see Fence Houses East Eetfoed Peitchaed, W. B., Loc. Sec. Eogers, Charles, E. H. Savile, G. I., M.D. Eccles see Manchester Eckington see Sheffield Egremont see Whitehaven Elland Hamerton, John Hiley, James Ely , . Muriel, John, F.E.C.S., Loc. Sec. Lucas, Thomas, Bunvell Wales, T. G., Dotvtiham Market Emswoeth Stephens, D. W., M.D. Baxter, W. E., M.D. Enfield Godfeey, B., M.D., Loc. See. Epping Lcgg, A. Epsom Jones, Arthur O'Brien EwELL Barnes, G. E., M.D. Evershot see Dorchester ExETEE Lyle, Thomas, Loc. Sec. Devon and Exeter Hospital Library Kempe, A. Perkins, Samuel S. Eoper, C. H. Shapter, T., M.D. Sanders, G. J. S., M.B., Exminster Exminster see Exeter ExMouTH EicHAEDsoN, Ealph A. M., M.D., Loc. Sec. Land, W. H. Turnbull, G., M.D. FALMorTH GuppY, T. Stokes, M.D., Loc. Sec. Yigurs, E. C, M.B. Farndon see Chester Faeningham Ashurst, W. E., M.D. Fawley see Southampton 118 MEMBERS. Fence Houses Cuny, W., JEast Rainton Fenitt Steatfoed Deyns, F., M.D. Feeeyhill Clark, H., M.D. Fincham. see Ely FiNCHLET . . . . , Hochee, J. Fishguard see Haverfordwest Folkestone Bowies, Robeex L., M.D., Loc. Sec. Bateman, W. Eastes, Sylvester Tyson, W. T. Wildash, H. C, M.D., Eythe Fagge, Frederic, Sythe Feampton-on-Seveen .... "Watts, Thomas Feome Bush, Edward, Loc. Sec. Fro-ulog see Dolgelly Fyfield see Devizes Gainsboeough Mackindee, D., M.D., Loc. See. Smallman, J. C. B., M.D., Willingham Gateshead see Newcastle-upon-Tyne Gloucestee Evans, T., M.D." Graves, E,. W. Keddell, W. Godalming see Guildford Gomersal see Leeds GospoET Ashforth, G. M., M.D. Geantham Shipman, K., Loc. Sec. Geavesend Aemsteong, J., M.D., Loc. Sec. Crook, J. E., M.D., Northfleet Gould, Samuel Nisbett, E,. J., Overcliffe Pinching, C. J. Great Eccleston see Manchester Great Witley see Bewdley * Greenend see Aylesbury Greenfield see Llanelly Greenwich see Blackheath Gbeat "Waejeeing Dewar, J., L.R.C.P, GuEENSEY Corbin, M. A. B., St. Peter's CoUins, — , M.D. GuiLDFOED Sells, T. Jennee, Loc. See. BoxaU, H. Surrey C. Hospital SutclifFe, J. Eipley Yate, F., Godalming GuisBOEouQH Merryweather, J. H. Hadlow see Tunbridge "Wells MEMBERS. 119 Haiifax Bramley, Lawrence Jubb, Abraham Waite, Wm. Haxton Carruthers, "W. Hambrook see Bristol Hampton see Kingston-on-Thames Hanwell Lindsay, J. Murray, M.D. Eichards, J. Peeke Harborne see Birmingham Haklow Day, Eobeet N., Log. Sec. Clegg, Joseph, JEpping Harpurhey see Manchester Haekoqate Myrtle, A. S., M.D. Haeeow-on-the-Hill . . Bridgwater, T., M.D. Hartlepool Edger, P. M. Mackechnie, D., M.D. Morison, J., M.D., Wingate Haslingden- . , Aspinall, W., M.D. Hastings Undeewood, John, M.D., Loc. Sec. Adey, Charles, M.D., St. Leonardos East Sussex Medico- Chirurgical Society Lloyd, Thos., M.D., St. LeonarcVs Savery, James, M.D. TroUope, Thomas, M.D. Hayant i Aldersey, W. H. Hayerfobdwest Beown, J. D., M.D., Loe. Sec. Evans, M., M.D., Narherth John, WiUiam Owen, John, Fishguard PhiUips, Ed. P. Hatle Mudge, James Hawkshead Parsons, G., M.D. Heighington see Darlington Helmsley see York Helpesley see Harrogate Hemswoeth Leak, Thomas, M.D. Henfleld Lewis, C. F., L.K.C.P. Ed. {Exam.) Henley-on-Thames .... Brooks, A'Doyley Hexham see Newcastle-upon-Tyne Highworth see Swindon Higher Broughton see Manchester Higham Ferrers see Northampton High Wycombe Bowstead, E. M., M.D. Turner, John HiTCHiN Shillitoe, E. E., Loc. Sec. Hogsthohpe Eainy, W. B., M.D. Holbeach see Spalding 120 MEMBERS. Holbeck see Leeds Hollingwood see Manchester Hooton Elms see Chester Hooton Pagnell see Doncaster HoLLiNGWoRXH Pomfret, Hy. L. Holyhead Williams, Ed., Drouwy LlanfacJireth Holywell Dayles, Jesse C, M.D., Loc Sec, Jones, T. E., Llanasa Horncastle see Wisbeach Horrabridge see Plymouth Houghton-le-Spring see Newcastle-upon-Tyne HoviNGHAM Gillard, E. HowDEN Grieve, E., M.D, Htjddeesfield Booth, S. Haigh, Thos., Meltham Hull King, Kelbotjrne, M.D., Loc. Sec. Cooper, Sir H., M.D. Craven, E. M. Daly, 0., M.D. Dossor, James Gibson, John H. Healey, Edward Infirmary Library Locking, J. A. Sharpe, Eichard Hulme see Manchester Htjniingdon Poster, Michael, P.E.C.S., Loc. Sec. Book Society Newton, L., Alconlury Hill Hurworth-on-Tees see Darlington Hythe see Folkestone Ibstock see Leicester Ilkley see Otley Ilkley Harrison, "W. P., M.D. Ipswich Hammond, C. W., M.D., Loc. Sec. Bech, H., Needham Marlict Book Society Chevallier, B. Elliston, G. S. Sampson, G. G. Jarrow see Newcastle-upon-Tyne JERSEY Yaudin, Charles, M.D., Loc. Sec, St. Ilelier^s Blood, Michael, M.D. Godfrey, Alfred, M.D. Keighley see Leeds Kettering Dryland, TV. J. MEMBERS. 121 Kibworth see Leicester KiDPKKMINSTEE lloDEiSr, AY., !N[.D., ZoC. SeC. Kinber see Stourbridge KiNQSBEiDGE Elliott, JoHif, Zoc. Sec, TresUUan Cornish, Franc. S. Newman, Augustus, M.D., Barimoidli Kingscliffe see Stamford King's Teignton see Teignmouth KiNGSTo:N^-oN-TnAMES .... Kershaw, "W. W., M.D., Loc. Sec. Carfrae, O. M., M.D., Surhifon Coleman, M. T., Surbifon Dukes, Clement Gunning, John, Surhiton Gunther, T., M.D., Surhiton Hotham, R. H., Thames Litton Izod, Charles, JEshey Jepson, Henry, Hampton Jones, Price AY., M.I)., Surhiton Mott, Charles, WaUon-on-Thamea KiNTBrET, HuNGEEFOKD. . Liddcrdalc, John Kirton in Lindsey see Gainsborough Knaeesboeough Anderson, James, M.D. Knipton see Leicester Lacoclc see Chippenham Langi'ort Peankeed, J., Loc. Sec. Larcombe, John Langwathly see Penrith Leamingtox Eeeage, Thomas, Lgc. Sec. Baker, R. L. Clark, James F. Collins, C. P., M.D. Crighton, A. AY. Horniblow, E. E. B., M.D. Slack, R., M.D. Thomson, T., M.D. Leake see Boston Leatherhead Courtne}', Sydney Ledbtiet AYooD, Miles A., Zoc. Sec. Lee Pai'k see Greenwich Leeds AYeight, C. J., Zoc. Sec. Brooke, AA''., IZemsJet Carter, J. B., Fotternexvton Chadwick, C, M.D. Clare, AY. Clark, J. C, Gildesome Cockcroft, Thomas H., M.D., Keiglihy Corrie, J. J. 122 MEMBEKS. Leeds, continued Craister, T. L., Bramley Ellis, John R., MirfieU Ellis, John, Hechmondivic'ke Poster, E., M.D. Gisbarn, J. J. W. Greenwood, J. "W., Osnett, WakeMd Hall, Frederick Hallilay, John Handcock, George Hayward, G., M.D, Hey, Samuel Holmes, Frederick Horsfall, J. Horton, R. J. Jessop, T. R. Kelly, G. P. Land, R. T., M.D. Loe, J. S. Mann, David McGill, A. P., Infirmary Nunneley, Thomas Price, W. N. Ramsbotham, S. H., M.D. Ramskill, Josiali Scattergood, Thomas School of Medicine Scott, AV., Bolhech Seaton, J. Teale, T. P., M.B., M.A. Ward, J. J3. "Wheelhouse, C. G. Leek Cooper, RiCHAiic, Loc. Sec. Heaton, Charles Leicestek Baeclat, J., M.D., Loc. See. Blunt, T., M.D. Eddowes, J. H., M.D., Lougliborougli Francis, John, Ilarket JIarhoro'ugh Franks, AY. F., Billesdon Fulshaw, Ralph, Earl's Skilton Hatchett, J., M.D., Ravenstone Leicester Infirmarj' Library Leicester Medical Book Society Macaulay, Thomas, Kihworth Marriott, J., Kihworth Robinson, J. C, Syston Thomas, R. H., Ihstock "Whitchurch, Nathaniel, Melton Iloivlray Wright, J., MarlfieU MEMBERS. 123 Leicestee, continued "Wright, S., Mount Sorrel Wood, J. A., Shee^shcd Leighton Btjzzakd Lawford, E. D., M.D. Leintwardine see Leominster Leytonstone Cooper, ¥. "W. Leominster Babnett, Samtjel, Zoc. Sec. Lewisham Freeman, E. T., M.D, Leyland see Preston Lichfield Welchjian, C. E. E., Zoc. Sec. Davis, E. A., M.D., Burntwood Morgan, Major Lincoln Symi'son, Thoiias, Zoc. Sec. Broadbent, Ed. Farr Harrison, C, M.D. Lowe, George May, M.B, O'l^eill, 'William, M.D. LiSKEAED Corin, J. Littlebourne see Canterbmy Llanasa see Holywell LivEEPOoL BuEEows, J., M.D., Zoc. Sec. AUcock, C, Waterloo Bickersteth, E. R. Bickerton, T. Call an, W. J., M.D., Islington Chalmers, D., M.D. Crccgcen, J". N. Dawson, J. Drysdale, J. J., M.D. Eden, Thos., Aighvrth Gee, E.., M.D. Gill, G. Greenwood, H. Grimsdale, Thomas E. Hakes, J. Imlack, H., M.D. Inman, Thomas, IM.D. Long, James Manifold, W. H. Mason, M. G. Medical Institution Nottingham, J., M.D. Parker, Ed. Prythei'oek, John Eoyal Infirmary Smith, C. B., Sea forth Smith, J. Iv., M.i). Taylor, J. Stopford, M.D., Everton e 2 124 MEMBERS. Liverpool, continued .... Walker, G., M.D., Booth Whittle, E., M.D. AVigles worth, A. Llandudno Nicoll, Jas., M.D. Llandovery Thomas, David, Loc. Sec. Llanelly Thomas, Benjamin, Loc. Sec. Thomas, Richard, Greenfield James, J. R. Jones, T. M., Loughor Lofthofse, Redcar .... Sanderson, Marwood LONDON. Adams, John, 10, FinsLurj^ Circus Adlard, J. E., Bartholomew Close Alison, S. Scott, M.D., 85, Park Street, Grosvenor Square Allen, Peter, M.D., 15, Savile Row Allen, Messrs., 13, Waterloo Place Allen, E., 12, Tavistock Row Allingham, W., 36, Finsbury Square Amsden, G. J., M.D., 85, St. Paul's Road, Highbury Andrew, Jas., M.D., 59, Russell Square Andrews, J., M.D., 149, Camden Road Arthur, Jolm, M.D., 14, Commercial Place, Commercial Road East Ayerst, W. E., 20, Holies Street, Cavendish Square Baines, M., M.D. {for Westminster Medical Booh Sociefi/), 11, Cranley Place, Onslow Square Ballard, Edward, M.D., 7, Compton Tei-race, Islington Ikillard, Thomas, M.D., 10, Southwick Place, Hyde Park Bautock, G. G., M.D., 44, Cornwall Road, Westbourne Park Barclay, A. Whyte, M.D., 23a, Bruton Street, Berkeley Square Barnes, Robert, M.D., 31, Grosvenor Street, W. Banictt, Thomas W., 72, Fore Street, Limehouse Bartlett, W., I^adbroke Lodge, Ladbroke Square Barwoll, R., 32, George Street, Hanover Square Bateman, Hy., 32, Compton Terrace, Islington Beale, Lionel S., F.R.S., 61, Grosvenor Street Beck, T. Snow, M.D., 71, Portland Place Bennett, J. R., M.D., 15, Finsbury Square Birkett, Edw. Lloyd, M.D., 48, Russell Square Bowman, W., F.R.S., 5, Clifford Street, Bond Street Bristowe, J. S., M.D., 11, Old Burlington Street Broadbent, W. H., M.D., 44, Sej-mour Street, Portman Square Brooke, Chas., M.A., F.R.S., 16, Fitzroy Square Brown, Thomas, M.D., 236, Kennington Park Road MEMBERS. 125 BroAvii, Thomas, 16, Finsbuiy Circus Brown, J. H., M.D., 55, Gordon Square Bruntou, J., M.A., M.D., 207, Caledonian Eoad Bryant, Thomas, 2. Finsbury Square Buchanan, G., M.D., 24, IS'ottingham Phicc Burge, F. J., Junr., Stowc Lodge, New lload, Hammersmith Burrows, G. W., M.D., F.B.S., 18, Cavendish Square Bush, John, the Betreat, Clapham Butt, ^Y. F., 17, South Street, Park Lane Buzzard, T., M.D., 56, Grosvcnor Street, W. Cazenovc and Co., 15, Beaufort Buildings, Strand Clieetham, J., M.D., 54, Canonburj' Boad, Islington Chcpmell, E. C, M.D., 22, Cavendish Square Cheyne, E. R., 27, Nottingham Place, Marylcbone Chippendale, John, 16, Upper Phillimore Place, Kensington Cholmeloy, AVilliam, M.D., 40, Eussell Square Cholmondeley, Joseph, 3, Nottingham Place Church, W. S., M.D., 2, Upper George Street, Bryanston Square Clapton, E., M.D., St. Thomas's Street, Southwark Clark, Andrew, M.D., 16, Cavendish Square Clarke, Yans, M.D., Model Prison, Caledonian lload Clifton, Nathaniel H., 20, Cross Street, Islington Clover, J. T., ^', Cavendish Place Cock, Ed., Dean Street South, St. Thomas's Street, Southwark Cockin, John, M.D., UN. Coleman, Alfred, 32, Old Burlington Street Cole and Co., 85, Gracechurch Street Congdon, J., Guy's Hospital Cooke, ^Y. M., M.D., 39, Trinity Square, the Tower Cooke, E. H., Church Street, Stoke Newington Corner, F. M., Manor House, Poplar Couper, John, M.D., 28, Paik Street, Grosvenor Square Cowell, George, 65, Belgrave Eoad, Pimlico Critchett, George, 21, Harlcy Street Croft, John, St. Thomas's Hospital, Newington Crosby, T. B., M.D., 21, Gordon Square Curgenven, J. Brendon, 11, Craven Hill Gardens, Bayswatcr Daldv, T. M., M.D., 41, Finsbury Square Daniell, — , M.D., 20, Cathcart Eoad, "West Brompton Davis, Franc. ^Y., E.N. Davies, Herbert, M.D., 23, Finsbury Square Davy, Eichard, 33, AVelbeck Street, Cavendish Square Deacon, S., King Street, Borough (4 copies) Deane, J. De Mussy, Guenau H., M.D., 4, Cavendish Place Denny, John, 1, Summer Terrace, Brompton De Morgan, E., 6, Mertou Eoad, Adelaide Eoad Down, John S. H., M.D., 39, Welbcck Street, Cavendish Square 126 MEMBERS. Dowsou, E., M.D., 117, Park Street, W. Druitt, Robert, M.D., 37, Hertford Street, May-fair Drury, W. V., M.D., 7, Harley Street Duckworth, Dyce, M.D., 11, Grafton Street Dunn, Robert, 31, Norfolk Street, Strand Durham, Arthur E., 82, Brook Street Dudgeon, E.. E., M.D., 53, Montagu Square Duncan, Jas., M.D., 8, Henrietta Street, Coveut Garden Earle, Beresford N., 5, Euston Grove, Euston Square Easton, J., M.D., 20, Connaught Square Engall, Thomas, 15, Euston Square Erichseu, J. E., 6, Cavendish Place Fagge, C. H., M.D., 11, St. Thomas's Street, S.E. Penwick, S., M.D., 31, Harley Street, Cavendish Square Fergusson, Sir AV., Bart., P. U.S., 16, George Street, Hanover Square Pergusori, G. B., 14, South Square, Gray's Inn, W.C. Forbes, John Gregory, 82, Oxford Terrace, Hyde Park Fotherby, H. I., M.D., 3, Pinsbury Square Freeman, "W. H., 29, Spring Gardens Fuller, Hy. W., M.D., 13, Manchester Square Garden, A., M.D., 4, Clifton Road, St. John's Wood Garlick, W., 33, Great James Street, Bedford Row Ghose, P. C. Gibb, Sir George Duncan, Bart., M.D., 1, Bryanston Street, Portman Square Gibson, J. R., 10, Russell Square Gilbert and Co., 18, Gracechnrch Street ' Giles, Samuel, M.D., Kent Yilla, Lewisham Road, S.E. Godfrey, John, M.D., 33, Pinsbury Square Goldsmid, Augustus, 19, Ryder Street, St. James's Goodeve, E., M.D., Goodfellow, S. J., M.D., 5, Savilc Row Goodiich, P., Thistle Grove, West Brorapton Gougcr and Co., 8, Billiter Square Gowlland, Peter Y., 34, Pinsbury Square Graham, John, M.D., 29, Gloucester Roady Regent's Park Greenhalgh, R., M.D., 72. Grosvenor Street Griffith, John T., M.D., Talfourd House, Camberwell Grindlay and Co., 55, Parliament Street (for Dr. Thornton) Gull, W., M.D., 74, Brook Street Habershon, S. 0., M.D., 70, Brook Street Harrison, A. R., M.D., Pembroke House, Mare Street, Hackney Hare, Charles J., M.D., 57, Brook Street Hawkins, Caesar H., P.R.S., 26, Grosvenor Street Heath, Christopher, 9, Cavendish Place Henry, Alexander, M.D., 16, Great Coram Street, Brunswick Square MEMBERS. 127 Hewan, A. E. 'W., M.D., 8, Minera Street, Eaton Square Hewett, Prescott G., 1, Chesterfield Street, May-fair Hewitt, Graily, M.D., 36, Berkeley Square Hill, M. Berkeley , M.B., 14, Weymouth Street Hilton, John, 10, New Broad Street Hinton, James, 18, Savile Row Hodgson, W., Prince of "Wales's E-oad Holland, Sir Henry, Bart., P.R.S., D.C.L., LL.D., 72, Brook Street Holmes, Timothy, M.A., 31, Clarges Street Holman, W. H., M.D., 08, Adelaide lload, Haverstock Hill Holthouse, Carston Hood, Peter, M.D., 23, Lower Seymour Street, Portman Square Hulke, J. W., 10, Old Burlington Street Hunterian Society, Blomfield Street, Pinsbury Circus Hutchinson, Jonathan, 4, Pinsbury Circus Jackman, T. S. H., M.D., 41, Nelson Terrace, Stoke Newington Jackson, Hughlings, M.D., 28, Bedford Place Jackson, T. Carr, 3, Weymouth Street, Portland Place James, W. Prosser, M..D., 18, Dover Street, Piccadilly Johnson, George, M.D., 11, Savile Pow Jones, Hy. D., 12, Korfolk Crescent, Hyde Park Jones, C. Handfield, M.D., 49, Green Street, I'ark Lane Jones, T., Bookseller, Aldersgate Street Jones, Sydney, M.B., 15, St. Thomas's Street, Borough Kent and Co., Paternoster Bow Kibbler, R. C, L.R.C.P., Mordaunt House, Mare Stfeet, Hackney Kimpton, R., Wardour Street (2 copies) Kimpton, H., Holboni King and Co., Cornhill Kisch, Joseph, 2, Circus Place, Finsbury Circus Lane, S. A., 2, Berkeley Street, Piccadilly Langer, Ignatius, M.D. Langmore, J. C, M.B., 12, Sussex Gardens, W. Lawrence, J. E., Wandsworth Lawson, George, 12, Harley Street, Cavendish Square Leadam, Ward, M.D., 26, Gloucester Terrace, Hyde Park Leared, Arthur, B.A., M.D., 12, Old Burlington Street Lewis, H. K., 136, Gowcr Street Lewis, William, 21, Paddington Street, Marylebone Le Page, Whitefriars' Street (2 copies) Ligertwood, J., M.D , Royal Hospital, Chelsea Little, W. J., M D., 71, Brook Street, Grosvenor Square Loane, J., 1, Dock Street, Whitechapel Lockhart, W., M.D., Park Villas, Granville Park, Blackheatk Lockwood and Co., Paternoster Row London Hospital Library 128 MEMBERS. Longman and Co. (7 copies) Lorimer, J., M.D., The Medical Club, Spring Gardens Love, James, 26, Burton Street, Eaton Square Low and Co., Paternoster Eow Macdougal, H. E. S., M.D., 1st Regiment Scinde Irregular Horse McCarthy, Dennis, M.D., R.N. McCoy, — , M.D. Madden, H., M.D., 16, Westbourne Street, Hyde Park Marcet, ^Y., M.D., 48, Harlcy Street Mackenzie, M., M.D., 13, Weymouth Street Markwick, Alfred, M.D., I, Leinster Square Martin, Sir J. Ronald, M.D., 37, Upper Brook Street Mason, Samuel, M.D., 44, Finsbury Circus Meadows, Alfred, M.D., 27, George Street, Hanover Square Medico-Chirurgical Society, Berners Street Medical Society, University College Medical Societj', 30, Queen Street, Cannon Street Medwin, A. G., M.D , 11, Montpelier Row, Blackheath Meryon, E , M.D., 14, Clarges Street, Piccadilly Middlesex Hospital Libraiy, Berners Street Miller, C. M., M.D., Claremont Villa, Stoke Newingtou Road Miller, Benjamin, 17, St. James's Place, St. James's Street, Piccadilly Morrell, L. G., Wallingford Lodge, Riverhead Morgan, D. L., R.N. Morrison and Co., 2, Crown Court Moxon, W , M.D., 6, Finsbury Circus Murchison, Charles, M.D., 79, Wimpole Street Nash, Edmund, M.D., Royston Lodge, Ladbroke Grove Neatby, Thomas, M.D., 29, Thurlow Road, Hampstead Newton, E., 4, Upper "Wimpole Street Newton, G. B., R.N. Nichol, Robert, M.D., Denmark Hill Nichols, G. W., Augusta House, Deptford Road, Rotherhithe Nock, Bloomsbury Street, for McGill Library, Montreal Norton, George Everitt, 29, Upper Baker Street Ogle, John W., M.D., 13, Upper Brook Street, Grosvenor Square Oldham, Hy., M.D., 26, Finsbury Square Paget, James, F.R.S., 1, Harewood Place, Hanover Square Palmer, Thomas, M.D., 8, Radnor Place, Gloucester Square Part, James, M.D., 89, Camden Road Peacock, T. B., M.D., 20, Finsbury Circus Pearce, J. Chaning, The Manor House, Brixton Perkins, Houghton, 25, Mortimer Street, Cavendish Square Phillips, C. D. F., 107, Lancaster Gate Pick, Thomas P., -9, Bolton Row, May-fair MEMBERS. 129 Pickthornc, T. E., M.D. Pollard, F., 126, Euston Road Potter, J. B., M.D., 56, Maddox Street Potts, ^y., 12, North Dudley Street, Grosvenor Square Power, Heury, M.B., 45, Upper Seymour Street Poore, G. v., University College Hospital Priestley, W. 0., M.D., 17, Hertford Street, May-fair Price, W., University College Hospital Propert, John, 100, Grloucester Place, Portraan Square Purnell, J. J., Woodlands, Streatham Hill, S.W. Quain, llichard, M.D., 67, Harley Street, Cavendish Square Quain, E., F.R.S., 32, Cavendish Square Ramskill, J. S., M.D., 5, St. Helen's Place, Bishopsgate Street Richardson, — , M.D., 25, Gloucester Gardens, Hyde Park Richardson, E., 15, 'New Road, "Whitechapel Richardson and Co., Cornhill (for ilaclennan, — , M.D.) Ridge, Joseph, M.D., 39, Dorset Square Roberts, J. C, M.D., 7, Zetland Terrace, Ts'unhead Green, Peckham Roberts, A. Sydney, 20, Einchley Road, N.W. Roberts, J. H., 20, Finchley Road, NAY. Robinson, Thomas, M.D., 64, Lamb's Conduit Street Rogers, jSTathaniel, M.D., 11, Bath Place, Dalston Rogers, L. M., 31, Bouverie Street Roth, Matthias, M.D., 16a, Old Cavendish Street Salter, Hyde, M.D., 14, Harley Street, Cavendish Square Sanderson, J. B., M.D., 49, Queen Anne Street Saunders, W. S., M.D., 13, Quccn Street, Cheapside Scott, John, M.D., 8, Chandos Street, Cavendish Square Sedgwick, Leonard W., M.D., 2, Gloucester Terrace, Hyde Park Seely, — , Islington Green (for Islington Book Club) Semple, — , M.D. Sercombe, Edwin, 41, Brook Street Senior, C, Adelaide House, Adelaide Road North Searlc, J. C, 47, Milner Square, Islington Sewell, C. Brodie, M.D., 13, Eenchurch Street Seton, David E., M.D., 14, Alfred Place, Thurloe Square Shillitoe, Buxton, 34, Finsbury Circus Sibley, S. "NY., 12, New Burlington Street Sibson, Francis, M.D., 59, Lower Brook Street Simms, F., M.D., 46, "VYimpole Street Simpkin and Marshall (4 copies) Simpsou, F. H., 34, Fore Street, Cripplegate Sisson, R. S., M.D., 3, Warrington Terrace, Maida Vale Smith, Eustace, M.D., 28, George Street, Hanover Square Smith, Prothcroe, M.D., 42, Park Street mith and Son, 186, Strand 130 MEMBERS. Solly, Samuel, F.R.S., 6, Savile Eow Sotheran, Strand (7 copies) Spicer, Messrs., 19, New Bridge Street, Blackfriars St. Bartholomew's Hospital Library St. George's Hospital Library Stabb, H. D. Startin, J., 3, Savile Eow Steele, H. M. Stevens Brothers, 1 7, Henrietta Street Stevens, N. H., 14, Finsbury Circus Stevenson, Thos., M.D., 21, Caversham Road, Kentish Town Eoad Stewart, W. Ed., 12, Weymouth Street, Portland Place Stewart, A. P., M.D., 75, Grosvenor Street Stewart, H. C, M.D., 22, North Bank, Begent's Park Stoke Newington Medical Society Stone, W. H., M.D., 13, Vigo Street Story, William, 1, Havering Villas, Grove Street, South Hackuey Stuckey, J. Surgeons, Eoyal College of, Lincoln' s-Tnn-Fields Synnot, Eobt., M.D., 16, Eaton Terrace Tamplin, E. W., 33, Old Burlington Street Tanner, P. H., M.D., 9, Henrietta Street, Cavendish Square Tayloe, E., Clapham Common Tennison, E. T. E., M.D. (latcE.N.), 9, Keith Terrace, Shepherd's Bush Thompson, Sir Henrv, 35, Winipole Street, Cavendish Square Tliorowgood, J. C, M.D., 61, Welbeck Street Times, Hy. G., 23, Manchester Street, Manchester Square Toulmin, F., Upper Clapton Turner, D., 53^ St. Peter's Street, Islington Waggett, John, M.D., 4, Stanley Terrace, Kensington Park, "W. Waller, A., Islington Dispensary Watkins, E., M.D., 61, Guilford Street Watson, Sir T., M.D., 16, Henrietta Street, Cavendish Square AVatson, J., M.D., 6, Southampton Buildings, Bloomsbury Watson and Co. (for Dr. Jamieson) Webb, E., M.D., 247, Maida Vale, Maida Hill AVeber, Hermann, M.D., 10, Grosvenor Street Weber, Frederick, M.D., 44, Green Street, Grosvenor Square Wells, T. Spencer, 3, Lp])cr Grosvenor Street Weston, Philip, M.D., 1, Duncan Terrace, Islington Whitfield, E. G., St. Thomas's Hospital Whittaker and Co., Paternoster Eow Williams, C. J. B., M.D., F.E.S., 49, Upper Brook Street Williams and Norgate, for Westermann, New York for Chriestein, New York Williamson, J., M.D., 44, Mildmay Park Wilson, Erasmus, F.E.S., 17, Henrietta Street, Cavendish Square MEMBERS. 131 Wiuslow, F., M.D., 23, Cavendish Square "Wollowiez, Count, M.D. Woodhead and Co. (for Hadlow, H., N.W.) Woodman, ^Y. B., 10, Finsbnry Pavement "Wright, AY. H., Clapton Square, Hackney Long Sutton Hodgson, W. J., M.D. Longtown see Carlisle LosTwiTHiEL 'Row, C, M.D. Loughborough see Leicester Loughor see Llannelly Louth Faussett, F., Westgate Lowestoft Cluebe, W. H., Loc. Sec. Ray, Jas. Worthington, F. S. Luton Beds Woakes, Ed., M.D. Lond., F.L.S., Loc. Sec. LuTTEawoRTH Busgard, M., M.D. Lymington Hill, W. E., M.D. Lyndhurst see Southampton Lynn Woodward, E., L.R.C.P., Loc, Sec. Parry, George, Docking West Norfolk and Lynn Hospital Lynton Fairbank, F. E., M.D. Lytliam see Preston Maddeley see Bridgnorth Macclesfield Mottershcad, J. Maidenhead Playue, Alfred, M.D. Maidstone Fry, Fkedeeick, Loc. Sed Davies, A. Furley, Ed., M.D., Town Mailing Hoar, W. Joy, Hy. W. Monckton, S., M.D. Plomley, J. F. Pope, P. M., M.D., Town Mailing Pout, Hy., M.B., Yalding Sanders, Godfrey Williams, M.D., Aylesford MaLTON CoLBEY, W. T., Loc. Scc. Cross, E., M.D., Scarhoro'' Malteen WfisT, W. C, M.D., Loc. ^ec. Dawson, W. H. Weir, Archibald, M.D. Manchestee Simpson, H., ]\LD., Loc. Sec. Bardsley, Sir J., Bart., M.D. Barton, Samuel, WhalUy Range 132 MEMBERS. Man^chestek, continued . . Blackley, C. H. Hates, J., M.D., Ardivich Borcliarclt, L., M.D. Bradbury, J. 0. Browne, H., M.D. Caldwell, J., Hulme Coghlan, W. B. Clarke, A. C, Salford Coveney, Jas. II. Dumville, A. W. Fletcher, J. 0., M.D. Fletcher, J. S., M.D. Harrison, G. M. Heathcote, B. Heslop, R. J. Hutchinson and Earlc Ilderton, F., Droyhden Lancashire, J., Stand Leach, D. J., M.D. Library of Boyal Infirmary Library of Medical Society Little, D., M.D. Lund, Ed. Melland, F., Rusholme Morgan, J. E., M.D. Mould, G., Cheadle Ncsfield, S., M.D. Baton, Ilobert Peatson, J. C, M.D. Pierce, F. M. Pigg, Thos., M.D. Bains, John, M.D. liansomc. A., M.A., M.B. Beed, G., M.D., Infirmary Eenshaw, H. 8., M.D., Sale Boberts, D. L., M.D. Roberts, W., M.D. Roe, R., Eccles Smart, R. B. Smith, FaUoufield Southam, G. Stephens, J. Stone, Josh., M.D. Swift, Hy. Turner, Thomas Walsh, J. Wells, J. Whitehead, J., M.D. AVild, Thomas MEMBERS. 133 Manchestek, continued . . Wilkinson, M. A. Eason, M.D. Williams, R. H., Great Eccleston Williams, W. J., M.D. Wilson, Jonathan Windsor, J". Worsley, H., Ardwick Mannington see Bradford Margate Eowe, T. S., M.D. Market Boswortli see Leicester Maeket Drattox Saxton, W. W., M.D. Market Harborougli see Leicester Market Lavington see Devizes Market Oteetox Kow, W. Markfield see Leicester Marlborough . : Maurice, David P. Martock Westcoit, W. W., Loc. Sec. Masbororigh see Eotherliam Matching Green see Harlow Melbourn see Cambridge Melbourne see Derby Melksham see ChijDpenham Melksham Mccres, Ed., M.D. Melton Mowbray see Leicester MEumiR Ti'DviL Thomas, II., M.D. Messingkaim Lindsay . . Terrewest, W., M.D. Eussell, C. J. Middlesbro'-on-Tees .... RicuARBSON, JoHX, Loc. See. Coates, George Craster, T. W. Nixon, T. A. Wilson, Henry, Saltlurn-hy-the- Sea MiBHURST Ingram, W. G. L. MiLBORNE Tort Parsons, S. N. Milbrook see Southampton Mirfield see Leeds MiTCHAM Marshall, Ed. Mold see Chester Monkwearmouth see Sunderland Monmouth Prosser, Thomas, Loc. Sec. Moretox-ix-the-Marsh. . Yelf, Leonard K., M.D. Moore, G. Mount Sorrel see Leicester Munslow see Bridgnorth Nafferton see Bridlington Nayland see Colchester Needham Market Cooper, C, M.D. JS^eston see Chester 134 MEMBERS. JSTEWAEK-uPOif-TEENT .... "Wake, E. G., M.D., Collingham New Buckejjham Howard, H. F. Newbury Bunxy, J., M.D., Loc. Sec. Hawkins, T. H. Hemsted, Hy. Herbert, — Palmer, Silas, IT.D. New "Wimbledon Johnsou, E., M.D. Newcastle-tjndee-Lyne , . Acton, Walter {for Medical Book Society) Newcastle-upok-Tyne . . Philipson, G. H., M.D., Loc. Sec. Armstrong, Luke Arnison, W. C, M.D. Atkinson, J. I., Wylam Banning, R. J., M.D. {for Gateshead Medi- cal Society) Barkus, Benjamin, M.D. Brady, Hy., Gateshead ]')urnup, Martin, M.D. Carr, Chas. Charlton, Ed., M.D. Clarke, Rd. ^ Downie, G., Chester -le- Street Embleton, D., M.D. Gibson, Charles, M.D. Gibb, C. J., M.D. Grcgson, T. L. Honseman, J., M.D. Humble, Thos., M.D. Jackson, D., M.D., Hexham Kennedy, J. F. Library of Newcastle Infirmary Macaulay, J., M.D. Manford, P. W. Matthews, J., M.D., Tynemouth Murray, W., M.D. ^[urray, J. C, M.D. Nesham, W. Eavne, 8. W. Ronton, W. M., M.D., Shotlcy Bridge Russell, John Stainthorpe, G. P. Thompson, R. P., M.D., Jarrotc Thompson, T. Y. Tweddell, J., Jlouyhfon-le- Spring Wilson, R. H., M.D., Gateshead Newent Cattle, W. Druce Newick, Uckfield Graveley, R. MEMBERS. 135 l^ewmarket see Ely Newpoet, Monmouth , , Morgan, W. W., M.D., Loc. Sec. Davis, W. J. Limberry, Thos. Wooliett, H. F. Newport see Stafford Newpoet, Pembeoke .... Havard, D., M.D. Northampton Evans, Chaeles Jewel, Loc. Sec. Banks, P. H., Riseley, Higham Ferrers Erancis, J. T., M.D. Elewitt, M. W. Infirmary Library Moxon, Wm. Olive, George Percival, W. North Curry see Taunton Noethleach Howard, Jas. H. H. NoBTH Shields Peaet, E., M.D., Loc. Sec. Bourne, W., M.D. Bramwell, .John B., M.D. Northfleet see Gravesend Norwich Eobinson, Hatnes S., Loc. Sec. Arnold, Ed. Copeman, Ed., M.D. Eade, P., M.D. Johnson, John Godwin Manby, Frederick, Rudham Medico-Chirurgical Society Prangiey, T., Aldborough Taylor, Hugh, Coltishall Northwold see Ely Northwood see Bristol Nottingham Eansom, W. H., M.D., Loc. Sec. Beddard, J., M.B. General Hospital Library Howitt, Erancis, M.D. Higginbotham, M. H. Medico-Chirurgical Society's Library Stephenson, T. A. Stiff, W. P., M.B. Tate, M. B., M.D. Thompson, Jos. White, Jos. Wright, Thos., M.D. Odiham McIntyee, J., M.D., Loc. Sec. Sweeting, 11. B., Basingstoke 136 MEMBERS. Odiham, continued Webb, C, Basingstohe Oldham Piatt, Thomas, Loc. Sec. Bradbury, B., M.D. Thompson, A. T., M.D. Murray, Charles Old Park see Bristol Oemskiek Ashtou, T. M., M.D., Burscoiigh Ossett see Leeds OswESTKY Blaikie, Eobert Otley Scott, Thomas, M.D., IRley Macleod, W., M.D., Ben Bhy deling Ritchie, Thos. Ottery see Sidmouth OxFOED , . WiNKFiELD, A., F.R.C.S., Loc. Sec. Ackland, H. W., M.D. Freeborn, R. F., M.D. Jackson, P., M.D. Medico- Chirurgical Society EadclifFe Library Symonds, F. Thompson, W. A. Palmer, F. S. Padiham Booth, J. G. Paignton see Torquay Paiksavick Gaidncr, llichard C. Pendleton see Manchester Peniston see Sheffield Penrith Wicldiam, Joseph, M.D. Jackson, T., M.D. Pearson, P., M.D., Maryport Taylor, M. ^\ . Taplin, B. D., EirTcosivaJd Williamson, Joseph, M.D., Langivathly Pensford see Bristol Penzance Montgojieky, J. B., Loc. Sec. Boase, Franc. Harvey, W. G. Petebbokoitgh SocTHAM, G. T., M.D., Loc. Sec. McCaull, M., Whittlesey Pewsey see Devizes Plumsted see Woolwich Plymouth Whipple, Conn ell, Loc. Sec. Cla^-, Hogarth, M.D. Eccles, G. H., M.D. Graham, J. Harper, T. May, J. H. S. MEMBERS. 137 Plymotjth, continued .... Plymouth Book Society Treasurer of Thomas, — Square, W. J. Swain, P. "W., Levonport Willis, R. D., Uorralridge Pontypridd Phys, Watkin Portsmouth Bcntham, S., Southsea Martin, John, M.D. Portland Forbes, H., M.D., H.M.S. Boscaurn Potternewton see Leeds Preston Allen, P., Zoc. Sec. Berry, John, Leyland Fearnside, H., M.D. Hall, Jas. Hammond, J. H., M.D. Heslop, P. C, M.D. Rigby, J. llobinson, J. Spencer, Lawrence, M.D. PULBOROUGH Taylor, W. Eccles, M.D. Queen Camel Adams, H. Ravenstone see Leicester I^EADiNG Walford, T. L., Loc. Sec. Book Society May, G. Walker, I. H., M.D. Woodhouse, R. J., M.D. Workman, J. W. Young, W. B. Redland Webster, Thos. Redruth Hichens, Jas. S., Loc. Sec. Michell, G. W. A. Michell, S. Y. P. Reigate Walters, J., M.D. Rhayader Richardson, R. Rhyl see Chester Richmond, Surrey Maybury, A. K., M.D., Loc. Set. Duncan, Thomas, M.D. Hassall, R. D., M.D. Julius, F., M.D. Richmond, Yoreshxre . . Bowes, Rd. Rickmansworth see Uxbridge RiPON Collier, Tnos., Loc. Sec. Frankland, T. T. Paley, W., M.D. f 138 MEMBERS. EOCHESTER BeOWN-, I'UEDEEICK J., M.D., Loc. Sec. Aveling, J. H., M.D. Langston, John, Stroocl Tribe, Herman H., Chatham EocHFOED King, Thomas, Loc. Sec. Eockferry see Birkenhead EoMFOED Bott, C. G., Aveley EoTHEEHAir Sheaemax,E. J.,M.D.,r.E.C.S.,F.E.S.E., M.E.C.P., &c., Loc. Sec. Blythman, C. S., M.B., M.E.C.S., Swinto^i Bui-man, W. M., L.E.C.P. LoncL, M.E.C.S., L.S.A., Wath Clarke, W., M.D., L.E.C.S. Edinb., Went- worth Crowther, Jas., L.S.A. Foote, H. D., M.D., M.E.C.S. Hardwicke, J., L.K.Q.C.P. Irl., M.E.C.S. Oxley, William, M.E.C.S., L.S.A. Eobinson, Ed., M.E.C.S. SavQle, W., M.E.C.S., L.S.A. EoTHWELL , More, James, M.D. Eoyal Hill see Greenwich Eoyston see Cambridge Eoyton see Oldham EowxEY Eegis Phillips, D. W. Euabon see Wrexham Efgby Duke, Abraham, M.D. Eusholme see Manchester Eye Adamson, Ed., M.D. Eyde Barrow, B. Saffeoi^ Walden SxEAE, Hy., Loc. Sec. Welsh, Francis F. St. Albans Prior, E. H., M.D. St. Gebmans Kerswill, Eobert St. Helen's Twyfoed, E. P., M.D., Loc. Sec. Gaskell, E. A. Jamison, Arthur A., M.D. Eicketts, James St. Tudye Pearse, W. Salford see Manchester Saltburn-by-the-Sea see Middlesbro'-on-Tees Sandon, Stone Tylecote, J. H., M.D. Salisbury Wtlkes, W. D., Loc. Sec. Darke, F. E. P. Haynes, S., M.D. Sawbridgeworth Brickwell, J. ScAKBOROHGii CooKE, E. B., Loc. Sec. Craig, W. S. SIEMBERS. 139 SauiBOKorGH, continued . . Taylor, W. Teale, J. W. Scarboro' see Malton Seacomb see Birkenhead Seaton Carew see Stockton-on-Tees Sedbeegh Swain, "W. P. D. Sedgefield Smith, E., M.D. Shanklin Shrapnel, J. S. Shabxbeook Stcdman, R. S. Sheepscar see Leeds Sheepshed see Leicester Sheldon see Bishop Auckland Shepton Mallett see "Wells Sheeeness Swales, Ed., Loe. Sec. Sheffield 3Iarti:n- de Baktolome, M., M.D., Ediub., Loc. See. Barber, Jonathan Benson, John Booth, W. H. Branson, F., 31. D., Baslow Drew, S., M.D., Chapeltown Parell, ^Y. F. Frank-Smith, lE.D. Gleadall, Jas. Hall, J. C, F.E C.P. Edinb. Haslewood, A. V., Castleton Jones, J. T., EcMngton Jackson, Arthur Keeling, James Hiu'd, M.D. Edinb. Kemp, G. Merryweather, H. Parker, S. Porter, J. T. Eoberts, J. S., M.D. SheiQield Medical Book Soriety Taj-lor, E., Stop for (I Taylor, G., Stopford Thompson, Ed. Thompson, Cordon, M.D. Walker, Herbert Ward, J., Feniston Shepketh Dixon, W., M.D. Sheeboene NrxT, Hoeack, Loc. Sec. Shirley see Southampton Shotley Bridge see Newcastle-upon-Tyne SnEEwsBUEY Andrew, Edwtn, M.D. Clement, W. J., ^l.P. Glover, J., JJorrington /2 1 40 MEMBERS. Sheewsbuht, co)itinued . . Boe, J. W., M.D. Withers, E. W. 0. Slirivenhain see Swindon SiBFOED Feebis Knight, C. F. SiDMOUTH Mackenzie, J. J., M.D., Loc. Sec. Sleafoed Boot, John H., M.D. Somerby see Leicester SoTJTHAM Ruttlcdge, T. E. SorTriAMPTON Geiffin, B. W. ^V., M.D., Zoc. Sec. Aldridge, J. H., M.D. Beucraft, H. Collins, P., M.D., Staff- Surgeon, Woolston Dayman, H., Milbrook Mott, W., Shirlei/ Nunn, G. B., Lyndhurst Oliver, Jas. Orsboin, H., M.D., Bttterne Boyal Victoria Hospital Sims, W., M.B. Trend, T. W., L.K.Q.C.P. Ward, Thomas SouTHEXD Warwick, W. B., M.D. Southport see Liverpool SouTHPOET Mort, W., M.D. Southsea see Portsea South Suields Aemsteong, Leoxaed, Loc. Sec. Coward, AV., M.D. Frain, Jos., M.D, Bobson, Jas. SouxnwoLD Blackett, Ed. B., M.D. Spalding Cammack, Thomas, M.D., Lcc. Sec. Ball, Ancell, M.D. Morris, Edwin, M.D. Stiles, Hy. T., M.D. Vise, W. Foster Vise, Edward B., Holleach Wilkinson, W. C. Spilsby see Boston Staffoed CooEsoN, S., M.D., Loc. Sec. Blackford, J. C. Day, Hy., M.D. Masfen, W. E., M.B. Weston, E. J. Stmvtfoed jS'ewman, W., M.D., Loc. Sec. Medical Book Society He ward, J. M. MEMBERS. 141 Stamford, continued Skinner, W. A., Kingscliffe Stamford Bridge, Yorks. "VViight, Frederick Stand see Manchester Stickney see Boston St. Just see Penzance Stockport ^iv.h,'S .T).,1i:^.,Loc. 8ec., Beaton Chapel Downs, G., M.D. Graham, G. Y. Greenhalgh, T., M.D., Beaton Norrk Heginbottom, H. Massey, T. Eayner, W., M.D. Turner, G., M.D. Stockton-on-Tees Oliver, W. II., M.D., Loc. Sec. Toss, R. Laidler, J. Richardson, W. Trotter, A. E. H. Y^'oung, R., M.D., Yanii Stokesley see Stockton Stone see Aylesbury St. Leonards see Hastings St. Peter's see Guernsey Stotfold '. . . Mickley, G., M.B. Stourbridge Peeer, Alfred, Loc. Sec. Giles, P. Holyoake, Thomas, Junvcr Stradbroke see Diss Strangways see Manchester Stratford Mugliston, G. T. W., M.D., Zoc. Sec. Stratford- ON- Aton .... Nason, John J., M.B., Zoc. Sec. Kingsley, H., M.D. Medical" Book Club (Dr. Rico) Strood see Rochester Stroud Cubitt, G. R, Sudbury AVilliams, J., M.D. Sunderland Douglas, Mordey, Zoc. Sec. Barker, R. Bowman, H. 0., M.D., Jlloulireannouth Poote, C. N., M.D. Horau, J. Medical Society Smith, J., M.D., JWonlcwcarmoidh Smith, Taylor, M.D. Wellord, G., Bishojyiceannoidh "Wilson, J., M.D. Surbiton see Kingston-on-Thames 142 MEMBERS. Suttou Scotney see "Winchester SuTToisr-CoiDFiELD Bodiugton, G. F., M.D. SwixVDox SwiNHOE, S. M., L.E.C.P. LoncL, Loc. Sec. Sydenham Stuttee, F. A., M.D., Log. Sec. Grayling, — , M.D. tStillwell, S., M.D,, Bechenhani Turner, Sydney Wilkinson, F. E., M.D. Syston see Leicester Talaevor Eobcrts, J., M.D, Talgarth see Brecon Tarvin see Chester Tattenhall see Chester Tatjntoi^ LiDDoif, "W., M.B., Loc. Sec. Kinglake, Hamilton, M.D. Olivey, Hugh P., North Cumj Plowman, Tliomas, North Curry Teignmouth Lake, W. C, M.D., Loc. Sec. Baker, A., M.D., Lawlish Magrath, J. A., M.D. Tenteedex Saunders, Ed. Tetbt7ey Wickham, J. J., M.D. Tattenhall see "Wolverhampton Thames Ditton see Kingston-on-Thames Thame see Aylesbury Thetfoed Minns, P., M.D., Loc. Sec. Bousfield, E., M.D. TniESK Ryott, "W. Hall Thorne see Don caster Tickhill see Doncaster Tintern Parva see Chepstow Tolleshunt D'Arcy see Colchester TOEQUAY ]S[lND, P. P., LoC. ScC. Day, G. E., M.D. Dymock, "W., ThornMl Hounsell, H. S., M.D. Macreight, W. W., M.D. Medical Book Society IS'ankivell, C. B., M.D. Pollard, W. J. Pridham, C, H., M.D., Paignton Steele, "W. S., JEaston Tetley, J., M.D. Tottenham May, E. H., Loc. Sec. Cresswell, J., ITinchmore Hill "SVatson, W. T., M.D. MEMBERS. 14^ TowcESTER Watkins, E. ^Y., F.H.C.S. Town Mailing see Maidstone Tratton see Portsmouth Trowbridge see Bath Teuko Patjli,, Alexander, Zoc. Sec. Leverton, Hy. Spry Library of Eoyal Cornwall Infirmary Sharpe, Ed. TuysEiDGE "Wells BAimx, J. Milnee, M.D., Zoc. Sec. Duncan, E., M.D. Hooker, E. M. C, JTadlow Johnson, J., M.D. Sopwith, Hy. L. TuxsTALL Edwards, J. P. Twyford see Winchester Tyldesley see Manchester Tynemouth see Newcastle-upon-Tyne Fley Hall, J. TJptox-on-Seteen Braddon, C. UXBEIDGE MaCXAITAEA, G. 11., LoC. ScC. Gannon, J. P. Ventnoe Martin, G. A., M.D., Loc. Sec. Gooch, W., M.D. Tulliett, H. B. Walthamstow see "Woodford "\\^AKEFIELD Bl'OWn, M.D. Kemp, B., Jun. Kemp, E. "Walker, Castleford Stattcr, "W. "Walker, Thomas "Wallingfokd Baeeett, Ch. a., Loc. Sec. Barrett, H., Watlington Walmer see Deal "Walsall Burton, J., M.D. Maclachlan, J., M.D. "Walton-on-the-Naze see Ipswich Walton-on-Thames see Kingston-on-Thames Waemes'stee Bleeck:, C, Loc. Sec. "S^icary, G. Waeeingtok Davics, J., M.D. Dispensary Library Gornall, J. H. Sadler, P. Warwick Bridge see Carlisle "Wateringbury see Maidstone Watfoed lies, J. H. "W., M.D. "Wath-upon-Deane see Botherham 144 MEMBERS. "Watlington see Wallingford "Wellington, SoiiEKSEi . . Bridge, S. F., M.D. Pearsc, F. E., M.D. Wellington see Hereford Wells Mabden-Medlicott, C. C, M.D., Loc. Sec. French, J. Gr. Livett, — , M.D. Purnell, Thomas, M.D. Purnell, R., M.D. Purnell, E. W. Walker, W. C, Shepton Mallett Wem Salop Gwtnne, Samuel P., Loc. Sec. Willson, J. G. Wentwortli see Rotherham Westbourne sef. Chichester AVesi Beohwich Manlet, J., Loc. Sec. Duncalfe, H. Evans, A. P. Garraan, W. C, Wednesbunj Partridge, S., Barlaston UnderhQl, W., Tipto7i Underhill, T., Great Bridge Westbury-ou-Trim see Bristol Weston-super-Mare see Bristol Weston-super-Maee .... Alford, R., Loc. Sec. Martin, Ed. Wetmotjth ... Lush, M. Vandrcy, M.D. Wetbeidge Graham, A. R., M.D. Whalley Range see Manchester WHEATLEr Storin, C. F., M.D. Whitby Dowson, J., M.D., Loc. Sec. Mead, E. P., M.D. Yeoman, J., M.D. Whitehaven I' Anson, J". F., M.D., Loc. Sec. Dickson, J., M.D. Horan, — , M.D. Henry, — , M.D. Lawson, J. E. S., Egremont Wilson, J. B. Willingham see Gainsborough Wimbledon Love, G., Loc. Sec. Pocklington, E. WiNCANTON Surrage, J., M.D. Winchester Butler, F. J., M.D., Loc. Sec. Eldi-idge, F., Sutton Scotney England, W., M.D. MEMBERS. 145 WixcHKSTER, continued -. Godwin, Jas., Twyford Hants County Hospital Library Lipscombe, J. K., Alresford Wilde, J. "Winchmore Hill see Tottenliara "WiN-DEEjrERE Hamilton, A., M.D. "Windsor Bower, E., M.D., Loc. Sec. Casey, E., M.D. Ellison, — , M.D. Fairbank, Thos., M.D. Harper, J. P., M.D. "Wingate see Hartlepool "WisBEACH "Ward, H. S., Horncastle "WiTNEr Batt, Atjgustcs, M.D., Loc. Sec. "Wolverhampton Jackson", Vincent, Loc. Sec. Cooke, J., M.B., Tettenhall Eewnham, C. A. "Wolverton see Aylesbury "Woodford Bunce, J. S., Loc Sec. Drury, J. T. C, M.D., WaUhamstow "Woodstock "White, J. G., M.D. "Woolwich Mason, H., Loc. Sec. Library of the Herbert Hospital Bossy, E., M.D. Burton, — , M.D., Plums fed Butler, J. M., M.D, Wise, N. E., M.D., Plumsted Worcester Shcppard, Gr- Worthing Harris, "W. J-, Loc. Sec. Collett, H. J., M.D. Goldsmith, J., M.D. Wrexham Griffith, T. Taylor, Loc. Sec. Dickenson, J. Davies, Ed., M.D. Roberts, R. C, Ruahon Williams, Ed., M.D. Wrington see Bristol Wylam see Newcastle-upon-Tyne Yalding see Maidstone Yarmouth, Norfolk .... Palmer, C, Loc. Sec. Aldred, C. C. Smyth, S. T., M.D. Stafford, J". F. Vorcs, W., M.D. Whicker, — , E.N. 146 MEMBERS. Yaemouth, Isle op YfiGHT Hollis, C. "W., M,D. YoEK Shank, Gr., M.D., Loc. Sec. Ball, Alfred Christie, — , M.D. Draper, "W. DunhiU, C. H., M.D. Hood, W. Hornby, G. Husband, W. D. Keyworth, H. Matterson, — , M.D. Needham, F., M.D. IN'ess, John, JSelmsley North, S. W. Proctor, W., M.D. Reed, W. Williams, C, M.D. Wood, A., Kirly Moorside SCOTLAND. Abi-kdeen WionT, J., M.D., Loc. Sec. Adam, J. (for Dr. Powell) Best, S. v., M.D. Brown, D. Dyce, M.D. Davidson, D., M.D. Fiddcs, Da^-id, M.D. Praser, A., M.D. Jackson, Hy., M.D. Kilgour, Alex., M.D. Keith, W., M.D. Lawson, E., M.D. Medical and Chirurgical Society McHardy, J., M.D. Mortimer, W., Turriff Ogston, Francis, M.D. Reith, Archibald, M.D. Smith, W. D. J., M.D. University of Aberdeen AVallace, A., M.D., Turriff Airdi'ie see Edinburgh Anstruther see St. Andrew's Ai'broath see Dundee AucHTEKMiJcnTr Troup, Francis Bakfp Baeclay, J., M.D., Zoc. Sec, BAKEHiiAB Corbett, R. Beauley see Inverness MEMBERS. 147 Berwick- ox/Ttveed .... Turnbull, M. J., M.D., Loc. Sec, Cold- stream Paxton, J., Norham Bridge of AUau see Stirling Bo'ness see Linlithgo-w Campbeltow>" Gibsou, W., M.D. Crail see St. Andrew's Cum:>"ocb: Lawrence, J., M.D. Cumbernauld see Stirling Cupar see St. Andrew's Dalkeith see Edinburgh Denny see Stirling Dumfries Murray, P., M.D., Loc. Sec. Borthwick, A., M.D. Lewis, Paterson Little, — , M.D. M'Culloch, J. M., M.D. DuTvDEE Wixter, D., Loc. Agent Crockatt, W., M.D. Dewar, J. A., Arbroath Duncan, J. A. Gibson, W. L., M.D. Key, Andrew, M.D., Arbroath Medical Society Miller, J. W., M.D. Murray, W. F., Loc. See., Forfar Maclagan, Forfar Nimnio, M., M.D. Paton, D., M.D., Letham Porie, James, M.D. DuNDONALD Alexander, W., M.D. Eden-burgh Husband, W., M.D., Loc. Sec. Adams, M.D. Baltbxu', G., M.D. Balfour, Thomas, M.D. Balfour, Andrew, M.D., Poriobello Begbie, J. W., M.D. Bennett, J. H., M.D. Bishop, J., L.U.C.P. Brackenridge, D. J. Bryce, W.,^M.D., Dalkeith Burn, J., M.D. Cappie, j., M.D. Combe, J. S., M.D. Dickson, G., M.D. Duncan, J., M.D. Duncan, J. M., M.D. 148 MEMBERS. Edinbtjegh, continued . . Dunsmure, J., M.D. Furley, E. C. Gordon, M.D. Gordon, P., M.D., Jumper- Green Haldane, Eutherford, M.D. Irvine, James, M.D. KeiUcr, A., M.D. Kirk, J. B., M.D., Bathgate Keith, G. S., M.D. Kendall, W. B. Laycock, Thomas, M.D. Library, University of Edinburgh Livingstone, EdAvard Maclagan, D., M.D. Macgregor, D., Trane7it Maclaren, P. H., M.D., Lasswade Macdonald, A., M.D. Malcolm, E. B., M.D. Messer, T. J., M.D., Penicuick Middleton, J., M.D. Moffatt, — , M.D. Muirhead, C, M.D. Otto, John, Pathhead Patcrson, A., M.D., Brazil \ Pattison, Thomas, M.D. Eankine, P., M.D., Airdrie Eoyal College of Surgeons Eoyal Medical Society, Edinburgh Eoyal College of Physicians Sinclair, Y., M.D. Stewart, T. G., M.D. Thin, — (for Dr. Stoddart) Thomson, A., M.D. Valentine, — , M.D. Weir, T. G., M.D. Young, Jas., M.D. Young, Peter, M.D. Zeigler, W., M.D. jjj^cjjf Duff, Geoege, M.D., Loc. Sec. George, J. T., Jieith, Banff McKay, Morns, M.D. Turner, E., M.D., Keith Whyte, — , M.D. Forfar see Dundee Feaseebtjegh Grieve, A. C. Eyvie Greig, A. E. Gaieloch Eobertsou, C, M.D. MEMBERS. 149 Galashiels Somerville, H., M.D. Glasgow Dewae, Donald, M.D., Loc. Sec. Adams, J., M.D. Aitken, Jiio., M.D., Govan Anderson, T. McCaU, M.D. Alston, — , M.D. Buclianan, Simpson, M.D. Buchanan, T. D., M.D. Burns, J. Coats, J., M.D. Council, E., M.D. Co\yan, R. T., M.D. Dick, Jas., M.D. Dickson, J. B., M.D. Eadie, W., M.D. Easton, D., M.D., Fartick Fleming, J. G., M.D. Forrest, E. ^Y. Gairduer, W., M.D. Gemmel, J., Dunoon Golder, J., M.D. Goff, — , M.D., Rotlmell Gray, Jas., M.D. Greenhill, Dancan, Rutherglen Greenlecs, W., M.D. Henderson, T. B., M.D. Howatt, H. E., M.D. Lapraik, Thos., M.D. Leishman, W., M.D. Lister, Joseph, M.B. Library of University of Glasgow College Library of Glasgow Faculty of Medicine Library of Faculty of Physicians and Surgeons McGill, W. McGonville, J., M.D. McGregor, G., M.D. McLeod, G. H. B., M.D. Morton, Alex., M.D. Morton, Jas., M.D. Muiiro, Donald Newman, W., Steivarton Paterson, J., M.D., Particle Perry, Eobert, M.D. Prichard, W., M.D., Partick Eenfrew, Eobert, M.D. Eeid, Tbos., M.D. Eobertsou, A., M.D. Eobertson, G., M.D, 150 MEMBEES. Glasgow, contimied Eobertson, A. M. Russell, Thomas Simpson, A., M.D. Smith, Alexander Mc, M.D., Govan Spiers, Douglas, M.D. Spiers, — , M.D. Steele, Robert Steven, Robert Thompson, F. H., M.D. "Wotherspoon, "W". "Walker, Robert Yeaman, G., M.D. Glejtltjce McCormack, "W. Govan see Glasgow Hamilton London, Jas., M.D. Haddington Howdon, T., Jun., M.D., Loc. Sec. Martine, W., M.D. Hawick see Edinburgh Inverleithan see Peebles Inverness McNee, J., M.D. Jedbitrgh Rlair, M.D. Keith see Elgin Ejlmaenock Aitken, Jas., M.D. KiEKCTJDBEiGnT Johnstone, W., M.D. Laegs Campbell, John, M.D. Lasswade see Edinburgh Leatham see Dundee Leith Struthees, Jas., M.D., Loc. Sec, Henderson, Jno., M.D. Leewick Loeteebagh, p. D., Loc. Sec. Leuchars see St. Andrew's Leven, Eipe Balfour, J. Harrison, T., M.D. Liberton see Edinburgh Linlithgow Baird, G. D., M.D., Loc. Sec. Hunter, — , M.D. Murray, W., J3o^ness Lochgilphead Sibbald, J., M.D. Lowick see Berwick- on-T weed Luchars see St. Andrew's Monteose Howden, J. C, M.D., Loc. Sec. Fettcs, Jas., Laurencekirk Johnston, David, M.D. Lawrence, S., M.D. Officer, A. M., M.D. Simpson, J., L.R.C.S., Mary kirk Steele, G., M.D. Motherwell Caldwell, J. MEMBEES. 151 New Galloway Millman, A. McKiulay, M.D. Newport ue St. Andrew's Uorham see Berwick-on-Tweed Oekj^^e? Gordon, Adam, M.D., South Ronaldsluiy Paisley McKechnie, W., M.D., Loc. Sec. Donald, J. T. Graliam, Tliomas, M.D. Infirmary Library McKinlay, J., M.D., Barrhead Paton, Jas., M.D. Richmond, D., M.D. Taylor, D., M.D. Peebles Connel, J., M.D. Crawford, R., M.D. Perth Stiklin-g, D. H,, M.D,, Zoc. Sec. Prew, D. Irvine, W. S., M.D., Pitlochry Eoy, W., M.D. Peteehead Bruce, A., M.D., Dingwall Jamieson, P. PoETWiLHAM Douglas, J. C, M.D. Prestonpaxs King, J. L. Pitlochry see Perth Eatho see Edinburgh St. Axdeew's, Fife Bell, 0. H., M.D., Loc. Stc, St. Andrew^s Archibald, D., M.D., St. Andrew's Bonnar, G. L., M.D., Cupar Constable, J., M.D., Leuchars Lawrence, G., M.D., Crail Library of University of St. Andrew's Mackie, J, W. R., M.D., Cupar Stewart, J"., M.D., Newport AViseman, R., M.D., Cupar "Wright, P. L. W., M.D., Crail Stirling Gibson, C, M.D., Loc. See. Beath, A. Campbell, P., M.D., Bridge of Allan Findlay, D., M.D. Johnston, W., M.D. Rae, Jas. Stoneykirk see Stranraer Tain Sutherland, G. S., M.D. Tranent see Haddington Turriff see Aberdeen Wick Banks, G., M.D. 152 MEMBERS. "Wigtown Cuming, W. WisHAW Livingstone, J. IRELAND. Aboukir see Cork Ardee MooEE, Thomas J., M.D., Loc. Sec. Aemagh Cuming, Thomas, M.D., Loc. Sec. Armstrong, Jas., M.D. Leepcr, Jolin, Keady Lecper, W. W., M.D., Louglxall Pratt, Thomas, M.D., Mount ISforris, Market Rill Athione Langstaff, H. H., M.B. Longworth, — , M.D. Aughnacloy see Dublin Bagxalsxo'v^'n Traycr, Jas. S., M.B. Balbriggan see Dublin Bansoa Bradsliaw, Benjamin ^ Belfast Whitakee, H., M.D., Loc. Sec. Belfast Medical Society- Brown, Henry Douglas, W. Drennan, John S., M.D. McCormack, W., M.D. Murney, H,, M.D. Murray, H., M.D. Purdon, C. D., M.D. Purdon, H., M.D. E,ea, Samuel Stewart, Eobert, M.D. Wheeler, T. K., M.D. Belturbet see Cavan BrRE Scott, R. E. Boyle OTarrell, H., M.D. Bray see Dublin CAKEicK-ON-SinR Maetin, Jas., M.D., Loc. Sec, Portlaiv Fitzgerald, Alex. McMahon, Murphy J. R., M.D. Reynett, J., M.D., Portlaiv AVhite, T. K., M.D., KUsneelan Castlewellax Gray, George, M.D. Cavan Malcolmsox, W., M.D., Loc. Sec. Moore, M., M.D. Thomson, H. W., M.D., Leliurld "MEMBEllS. 153 Cloughjoedax Tv'alsli, A. D., M.D. C'oi?K FixN-, ErGENE, M.D., Loc. Sec, (folding, J. Punch., M.D. (fivag, Tlionia?, M.D. }ian-ev, J. E., M.D, {for Medical Ciub) llobart, N., M..D. Holmes, W . H., M.D. Sullivan, S., M.D. Tanner, X\\ K., M.D. Townsend, E. 11., M.D. Tovrnsend, W. C, M.D, Wall, J., M.D. DOAVXPATPJCK Maconchy, J. ]C. DliU3IXAGESS-\A DunloD, Joliu DrBLix MooEK, J. AV., M.D., Loc. Sec. Adams, E., M.D. J3anks, J. T., M.D. l^arker, ^Y. 0., M.D. .Barton, J. K., M.D. 13eattT, Thomas E., M.D. Bennett, E. II., M.D. Benson, C, M.D. Bigger, S. L., M.D. Bradv, Jas., M.B. Burke, ^y. M., F.K.Q.C.P. Byrne, J. A., M.B. Churchill, F., M.D. Colles, ^y., M.D. Cruise, F. B., M.D. Cryan, Robert, L.K.Q.CP. Darby, T., L.K.Q.C.P., JJrai/, Wichloxv Daxon, W., M.D. Dcnham, Jno., M.D. Dirham, J. A. Duncan, J. F., M.D. Dwyer, II. L., M.D. Egan, Ed. Elliott, W. A., F.E..C.S.L Evans, J., M.D. Fannin and Co. Fitzpatrick, T., M.D. Fleming, C, M.D. Foot, A. W., M.D. Fon-est, J. K., F.B.C.S.I. . Governor of Apothecaries' Hall Grant, Jas. F., L.B.C.P. Edinb. Grimshaw, Wrigley, F.ll.CS.I. Hamilton, Ed., M.B. 9 154 MEMBEES. DxJBLix, coufinued Hamilton, John, F.E.C.S.T. Hayden, Thomas, M.D. Hudson, A., M.D. Irvine, Haus, M.B. Jennings, "W. B. Johnston, George, M.D. Kiikpatiick, J. R., M.D. Kirkpatrick, F., M.D. King and Queens' College of Physicians Law, E., M.D. Ledwich, Ed., r.E.C.S.I. Library of Mcath Hospital Library of Adelaide Hospital Library of School of Physic Little, Jas., M.D. Madden, T. ^Y., M.D. M'Donnell, J., M.D. M'Dowell, B. O., M.D. M'Evoy, F. G., £a?bri(/f/an Marks, A. H., M.D. " 3Iartin, J. ^y., M.D. Martin, ^X. J., M.D. Minchin, H., M.D. Moore, C. F., M.D. Moore, ^y., M.D. Osbrey, Gerald, M.B. Purefoy, E. D. Purser, J., M.D. Eichmond Hospital Library Eingland, John, M.D. Eoyal College of Surgeons Eoyal Society, Dublin Eyan, J., M.D. Scott, W., M.D., Aiighnacloy Shaw, Jas. Sibthorpe, H. J., M.D. Smith, E. W., M.D. Smyly, P. C, M.D. Shannon, P., M.D. Stokes, W., M.D. Torney, Thomas, M.D. Tufnell, T. J., F.E.C.S.I. Trinity College Library Walsh, Albert, F.E.C.S.I. Wharton, J. H., F.E.C.S.I., M.D. Wyse, G., M.D. Enniscorthy see Wexford ExNisKiiLEX Walsh, E. F. MEMBERS. 155 Glaslougli see Armagh HoLLTiiouxT Barron, Gerald, M.D. Keady see Armagh Kilsheelan see Carrick-on-Suir KixGsxowx Adams, "\V. O'BsiEy, M.D., Loc\ Sec. Mahood, A. E., M.D. Telford, — , M.D. Letterkenuy see Londonderry Ltfford Little, 11., M.D., Cumhermore, Zoc, Sec. Liftord see Londonderry Limerick Kaxe, Thomas, jVLD., Zoc. Sec. LoxDoxDEiiHT Eerxard, W., L.H.K.Q.C.P.S.L, M.D., Loc. Sec. Browne, W., M.D. Cnthbert, Alexander, M.D. Darcus, — , M.D. Harkiu, John, M.Il.CS.E., L.E.C.P., Ediu. McCloskey, — , M.D. Miller, J. E., M.D. Thorp, Henley, M.D., LeUerhnmj White, Barncwall, M.D. Loughal see Ai-magli Malahide Lloyd, Hans, M.D. Stanistreet, Eichard, M.D. Mallow Galway, W., M.D., Loc. Sec. Berry, Parsons Mount Norris see Armagh Navax Hamilton, Francis, M.D. I^EWCASTLE Clarendon, S., M.B. Portlaw see Carrick-on-Suir Eathevaven see "Wexford EoscoMMox Haeeisox, J., M.D., Zoc. Sec. EossTREVOR Vesey, T. A., M.B. Sligo McMunn, J., M.D. Taxdragee Crawford, S. K., M.D. Waterford Mackest, G., M.D., Loc. Sec. Lloyd, W. H., M.D., H.M.S. Jason "Wexford Boxwell, H. H., M.D., Zoc. Sec. Boxwell, Eichard, M.D., Gorejy, Wexford Cardiff, J. E., M.D., Ratlievctvcn, Bal- linahola Cranfield, T. G., M.D., Enniscorthy Crean, E., M.D. Goodall, E., M.D. Wesxpoei Mahon, W. H.j M.D. 9^ 156 MEMBERS; EUEOPE. Lisbon Donnett, James J. L., JI.B, jj ^LTA Military Medical Officers, Garrison Hospital p^^ms , GiEALBES, J., M.D., Loc. Sec. Behier, — , M.D. Brown-Sequard, C. E., M.D Cor mack, lloso, M.D. Danyau, — , M.D. Marjolin, — , M.D. ASIA. BoaiBAT JoYNT, F. G., Zuc. Sec. Doolittlc, Frank, M.D. Hojcl, A. X., Bus/ere Hormiisjeo Ruttonjec, M.D., Ahmedcbad Joynt, C, M.D., Ahmedmiffgur Leith, A., M.D. Pirrie, J., M.D. Rogers, A. M. Semplc, — , M.D. Simpson, — , M.D. Calcitita Partkidgi;, G. B., Loc, Sec. Archer, — , M.D. (per Messrs. Thucker) Baboo Anando Lall Gaiigooly Baboo Bhoobun M. Chatterjec Baboo Gopaul Chundcr Itoy Baboo Hurri Kavain iJaiurJL'C Baboo Tvristo Chunder 8irbidicary Baboo Kylo Clmndcr Dutt Baboo Liickiuarain Hoy Baboo Moolvie Tamiz Khun Baboo Money Lull Dutt Baboo Mundo Lull Dhole Baboo I^emz Churn Bysack Baboo Eain jS'avain Dass Baboo Rain Chundcr Dutt Baboo Sath Cowry Dutt Beatson, — , M.D. Colles, J. H. P., M.D. Fayi-er, J., M.D. Futteh Singh, Bahadoor Greene, A. J., M.D. Harris, W. P., M.D, His Highness the Maharaja of Khetrie MEMBEES. 157 Calcutta, cuntini'.ed Macnamara, F. X,, M.D. Macnamara, J. Medical College Library Palmer, W. J. . , . Stork, "VY. (per Messrs. Thacker) CnujcEATA Walker, J. P., M.D FoEMOSA Maxwell, J. L., M.D, Lahoee Bkown, Buetois-, M.D., Luc. Sec. Gray, — , M.D. Lahore Medical Scliool Neil, — , M.D. Ealieen, Ehern, M.D. Scriyeii, — , M.D. Madeas CnipPERiiELD, W. K., L'jc. Sec. (Thirh < five Members) Ho^-(> KoxG General Military Hospital AFEICA: St. Helena (Island of) • ■ EoAvler, C. Hj S:eeea Leoxe Smith, Eobt^ Thomas, — , M.D, Maueitiuij Armv Medical Librtir^' S. AUSTEALIA. Adelaide "VYhittell, Horatio, M.D., Loc. Sec, Logan, — , M.D. I^OETH Adelaide Duncan, — , M.D., Fort Adelaide Ballaeat Macfarlane, AY., M.D. WESTEEK AUSTEALIA. Guildfoed "VYaylen, Alfred E., M.D. VICTOEIA. MiLBOtE^^E Baeicek, E., M.D., Zoc. Sec. (and Twentj-. nine Members) KEW SOUTH WALES. HobaSt Town Bright, Eichard S. Yass Campbell, Allan SiDjTEr McKay, — 15S MEMBEES. NEW ZEALAND. Nelson « S(iuires, — , M.D. CANADA. DuRHAii Gunn, J., M.D. Halifax Almou, — , M.D. MoxTEEAL IMcGill Library New Bkunswick Berryman, J., M.D., St. Jo/in^s Holdcn, C, M.D., ;S7. John's Howard, — , M.D. Nichol, F., M.D., Bdlcvilh MATJEITIUS. Army Medical Librai-y UNITED 8TATEt^. (No address given.) Brown, AV. T., M.D. (per Messrs. Cazcnovo and Co., 15, Beaufort Buildings, Strand) Cilly, J., M.D. do. Foster, N., M.D. do. Mackie, — , M.D. do. Mui-phy, J., M.D. do. Parvin, T., M.D. do. Yarndell, D., M.D. do. Ashurst, J. (per Mr. Skcet, King 'William Street, Strand) Barnes, Eobert do. Boker, E. S. do. Carter, C. do. Farnham, E. do. Hare, H. B. do. Lea, H. do. Stille, A. do. Wurtz, C. S. do. Triibncr and Co. (for One Member) Boston Saltee, E. H., M.D., Zoc. /Set-. Thii-ty-six Members' names not given Hastings, W. H., M.D. CixciNXATi Kearney, T. K., M.D. Murphy, — , M.D. BovEE Stackpole, P. A., M.D. MEMBERS. 159 Great Falls Eoss, J. S., M.D. Xkav York Wood, Messrs., Loc. Agents (22 copies) PniLADELPHn LixDSAT and Elaeistox, Loc. Agents Atlec, W. L., M.D., Philadelphia Beaver Co. ]\[cdical Society, Beaver Benham, 8. W., M.D., Pittslajiy Blouut, C. N.. M.D., Ti2}to)i Collins, J., M.D., Philadelphia Ciirwen, J., M.D., ITarridurgh Carpenter, J. S., M.D., Pottsville Da Costa, J., M.D., Philadelphia Dunott, T., M.D., Frederick Duuglisson, K., M.D., Philadelphia Evans, J., M.D., Little Roch Fleming, A., M.D., Pittslurgh Gaines, E. P., M.D., JfohiU Hay, T., M.D., Philadelphia Hood, A., M.D., Duhugue Jackson, J. D., M.D., Danville Jeffries, B. J., M.D., Bodon Kemper, G. W. H., M.D., Mnncie Lewis, S., M.D., Philadelphia Lyle, J. H., M.D., Bandridge Lippincott and Co., Philadelphia Lotliross, J., M.D., Bujfaloe Medical Book Club, Philadelphia Medical Society, Westchester Medical Society, Savannah Meigs, J. F., M.D., Philadelphia Meigs, J. A., M.D., Philadelpihia Moses, G. A., M.D., Mobile Mumford, S. E., M.D., Princeton Oritli, H. L., M.D., Sarrislurgh Philadelpliia Hospital Library, Philadelphia Prince, D., M.D., Jachonville Patterson, R. M., M.D., Storestown Hugh, J. W., M.D., New Alexandria Eeicher, G. A., M.D., Panama Schnlts, S. S., M.D., Harrishirgh Shire, P. C, M.D., Plainsville Stciner, L. H., M.D., Frederick Stetter, E. J. B., M.D., Marshalltcwn Stock, E., M.D., Philadelphia Strawbridge, J., M.D., Danville Yanderpool, S. 0., M.D., Albany Wagner, W. H., M.D., Woodsboro' Wey, W. C, M.D., Elmiree Whitehead, W. E., M.D., Cape Disap- pointment 160 MEMBERS. PfliLADELpniA, continued • ' Wright, C. 0., M.D., Cincinnuii And ten ■whose names are not given. EocHESTEE Sargeant, B. AV., M.D. SiNG-SiNO, jS". Y. Fisher, G. J., M.D. Helm, — , M.D. CAPE OF GOOD HOPE. Landsberg, Philip von, M.D. TRINIDAD. Port of Spaix Bakewell, — , M.D., Lcc. Sec. Dasent, B. S. Finlay, K., M.D. Knaggs, E. JAMAICA. Kingston Campbell, C, M.D, BAEBADOES. St. Josjepk Walt.cott, R., M.D., Loc. Sec. Manning, J"., M.D. Clark, ^V., M.D. Printed by "W. Clinkskel, 70, Paradise Street, Eotherhitlie. t^ UNIVERSITY OF CALIFORNIA LIBRARY Los Angeles This book is DUE on the last date stamped below. n-l^^ 'T/lK'^v^ OS-ANCEifj^ ^E cxf i /"^ — ^t ^^B ^Cl^I ^H 'JlWP 51 5 >- ^ ^^Bk' 1 J 17 ^ \ "^^ 1 tim IvdAil kJ}^ ZPV Tt