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cases he has found that there is an interval averagingfive days between the primary attack and the re-

lapse, an interval during which the temperature is normalor subnormal. This apyrexial interval may, as we

have just said, be wanting; it may last only twenty-fourhours, or it may be prolonged to ten days; but if a longerinterval than this should occur, it is likely that a mild re-lapse has taken place unobserved, and has been succeededby a more severe one. The occurrence of one relapse ap-pears indeed to predispose to a second. The average dura-tion of a first relapse is from twenty to twenty-one days,apart from complications, and when two or more relapsesoccur the later are shorter than the preceding ones, just asthe primary attack with a duration of twenty-eight daysexceeds the primary relapse. The subject, however, is oneof much difficulty, owing to the varying elements introducedby complications and " intercurrent relapses," and the con-fusion of true relapse with sequelse. Perhaps the pointwhich stands out most clearly in the research is the deter-mination of the temperature curve of the relapse. Thenumerous charts, which go so far to enable the reader tofollow the author’s statements, bring this out in a strikingmanner. The onset of the relapse is sudden, the tempera-ture reaching its height by the fifth day, and maintaining ahigh level till the eighth or ninth day, when it falls de-

cidedly, rising, however, afterwards, to decline gradually tothe twentieth or twenty-first day, when the relapse comesto an end, having passed through three distinct and well-marked stages. To most of us this must come like a re-

velation, and it will be well if the statement made on suchgood grounds should lead to a careful scrutiny of the tem-perature curves of typhoid fever. Firmly impressed withthe truth of this, the author has frequently been able todetermine, from a study of the thermometric curve, the ex-istence of a relapse where it was unexpected; and in casesof "ambulating" typhoid, where the relapse is the conditioncalling for treatment, the knowledge of the course and dura-tion of the pyrexia is of inestimable value.The foregoing is only a small part of the conclusions

arrived at by the author. Some of his statements require tobe carefully studied before their full import can be grasped;but his main conclusions are so rational that we have nodoubt they will be fully verified by others. Of late the tem-

perature in typhoid fever has been less studied than it shouldhave been. The exceptions to " Wunderlich’s law" seemedto be too numerous to justify the conclusions drawn from itby that acute observer. Now, however, we have some ex-planation of such exceptions, and we have almost formulatedfor us a " law of relapse." The modern treatment of typhoiddoes not lend itself very favourably to such studies; for un-doubtedly, if it do not prevent relapse, the practice of coldbathing interferes with the natural thermometric curve.

But, of course, this fact does not detract from the great meritof this book, one of the most careful and original contribu-tions to the clinical study of disease that has appeared for along time. ___________

Pseudo Hypertrophic Muscular Paralysis. By W. R.GOWERS, M.D., F.R.C.P., Assistant-Professor of ClinicalMedicine in University College, &c. London : J. and A.Churchill. 1879.THIS valuable monograph is a reprint, with additions, of

an interesting lecture which appeared in our columns inJuly, 1879, and contains analyses of 44 original cases,

which, with others referred to by various authors, make atotal of 220. A description of many of the cases is followedby a succinct account of the etiology, symptoms, prognosis,pathology, and treatment of this peculiar disease, so that inthis small work of sixty pages we have by far the most com-plete account of this interesting malady which has appearedin any language, and all clinical physicians must be greatly

indebted to Dr. Gowers for such an excellent synopsis ofthe main features of an affection which, although com.paratively rare, is so very striking that it immediatelyattracts attention. Among the chief points on which Dr.Gowers lays stress are that it is almost always a disease ofearly life, that it affects boys much more frequently thangirls, and that it is usually inherited through the mother,The prognosis is very grave, inasmuch as most of thesufferers die from broncho-pneumonia, and as treatment-cod-liver oil and mechanical exercise being the most im.portant-has but little effect on the progressive nature ofthe malady. The symptoms are clearly described and

explained, and the simultaneous increase of many muscles,especially those of the calf, with decrease in others, such asthe sterno-costal portions of the pectorals and the serrati, isshown by numerous drawings. The curvature of the spinein advanced examples is also strikingly illustrated. With

regard to the pathology of the disease, the author, after dis-cussing the theories which ascribe it to a primary affectionof the spinal cord, the sympathetic, or the "trophic nerves,r is of opinion that it is a primary disease of the striated mus-cular tissue due to a congenital nutritive and formativeweakness, and is in this opinion supported by Friedrich,This view is well argued, but we cannot say that we arequite convinced that this is a complete explanation of thestrange development of fat and fibrous tissue in the affectedmuscles. Detailed accounts of future cases will, we think,show that there is something behind the mere muscularchanges. A complete bibliographical reference to the cases.on record completes a most valuable work.

STEEVENS’S HOSPITAL, DUBLIN.

IN 1878 a coroner’s inquest was held at this hospital on aman named Anderson, a member of the constabulary, whohad been an inmate, in consequence of serious charges madeagainst the management of the institution. As a result ofthe evidence given at the inquest, a correspondence tookplace between Colonel Hillier, the Inspector-General of

Constabulary, and the governors, relative to the treatmentof constabulary patients in the hospital, and which has nowbeen issued as a Parliamentary paper, on the motion of Mr.Callan, M.P. for the county Louth, that the correspondencein question should be published. Colonel Hillier, in a letterdated September, 1878, drew attention to the system atthat time in force which permitted constabulary patients,who were charged Is. 4d. daily for their maintenance inhospital, to purchase from an C1nployé of the hospital articlesof food in addition to the dietary ordered by the medicalofficers. Further, that the patients in the constabularyward were left during the night without any nurse beingin attendance. He recommended that for the future nopost-mortem examinations should be undertaken, exceptwhere permission had been obtained from the nearestrelative of the deceased. The governors in their reply(October, 1878) acknowledge that the ward attendant hadbeen in the habit of selling food as alleged; that there werenurses hired to go through the wards at night and attend onsuch patients as required their assistance; and they promisedto comply with the recommendation of the inspector-generalas regarded post-mortem examinations. As two years elapsedfrom the date of the inquest to the time the member forLouth obtained the order for the publication of the corre.spondence above referred to, it is probable that he intendsagain to draw attention to the management of Steevens’sHospital.

THE Board of Medical Studies of Cambridge Uni-versity recommend that Mr. W. Hillhouse, B.A., of Trinity,be approved as a University teacher of botany, and Mr.James A. Lister, B.A., of St. John’s, be approved as aUniversity teacher of comparative anatomy.