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" The exceedingly foul online elavil breath so often produced by free smoking admits of only one remedy — abandonment of the pernicious habit. Other odors may, if strong enough, partially cover it, but it arises from destruc- tion and putrefaction of organic matter, elavil uses mostly of the blood mingled with the odors of the tobacco." We should like to know Dr. Palmer's authority for this statement. We fancy he would find it a difiicult search were he to undertake to establish it by the evidence of experiment, or even by the assertion of any one more scientific than King James I, of England. Of course, we can not, in the limited space of this journal at our com- mand, dwell to any considerable extent upon the descriptions of diseases given by Dr. Palmer, or on the views of their nature and treatment which he inculcates. We are, however, warranted in saying that there are very few subjects considered by him in which he does not show that he has failed to keep up with the progress of medical science. A few examples will show what we mean by this statement. Speaking of erysipelas, he elavil buy says : " It not unfrequently occurs ' spontane- elavil 10mg ously or idiopathically ' — that is, elavil 50 mg without a wound or abraded surface, or previous disease of the patient." This is in opposition to what we know of this disease : that it never occurs unless there is a wound or abraded surface. Nothing is said of the modern ideas of its pathology, nothing of its inoculabiiity, nothing of Orth's experiments. Indeed, the only au- thor quoted is Ilebra — and he only on a single point — whose observations were published twenty-two years ago. Dr. Palmer is clearly not aware of the fact that the uninjured cheap elavil skin is absolutely impervious to the poison of erysipelas. Dilatation of the stomach is considered in a few lines in conjunction with gastric obstruction, and no mention is made of elavil 25mg the sarcina3 ventriculi, which growths are almost pathognomonic of the affection. 596 REVIEWS elavil 10 AND LITERARY NOTES. In the account of pulmonary tuberculosis, no mention is made of Koch's experiments and researches. Exophthalmic goitre is treated of as a disease of the heart ! In the consideration of the subject of cerebral haemorrhage, no attempt is made to diagnosticate the seat of the lesion, the lenticular nucleus is spoken of as distinct from the corpus striatum, and the internal capsule, which plays so important a part in the morbid anatomy, is not mentioned in buy elavil online the whole course of the article. The whole subject of the pathological anatomy is discussed in thirty-two lines, and the remarks made are utterly devoid of significance. The chapters upon " cerebro-spinal sclerosis " and " bulbar sclerosis " are meager, unsatisfactory, and misleading. Certainly the author has no clear idea of these conditions. The like criticism may justly be applied to the sections on every disease elavil 50mg of the spinal cord which Dr. Palmer has thought it worth his while to con- sider. We do not know where elavil 10 mg more superficial and erroneous descriptions of spinal affections can be found than in the work before us. Dr. Palmer ap- pears to be in profound ignorance of the contributions of French and Ger- man neurologists, except occasionally as he gets some of them from abstracts in medical journals. lie appears to have read hastily certain English and American authors, and to have combined their observations indiscrimi- nately into a sort of hodge-podge of the most incongruous character. For instance, let us take one disease — pseudo-hypertrophic paralysis (and it is a fair example). Less than two pages is devoted to its consideration. He starts out with the incorrect assertion that " This is a form of disease hitherto observed in children only," and this is followed by the statement that it is thought that at an early period of the change an elavil mg oedematous state of the muscles contributes to swell their bulk." AVho thinks this, we are not informed, and the information has probably been privately confided to Dr. Palmer. Then elavil amitriptyline there is not a word in regard to the diagnosis. The disease is stated to elavil for anxiety be an affection of the muscles, without the reader being informed of the difference of opinion existing on this point. And then the extraordinary statement is made that " no lesions have as yet been dis- covered in the nerve-centers or elavil 25 the nerves." Indeed, we may say with truth that the whole division of the book de- voted to the consideration of diseases of the nervous system is unworthy of Dr. elavil used for Palmer's reputation and position as a teacher. Taken as a whole, we can not, consistently with our views of what a work on the practice of medicine should be, recommend the treatise before us, either to undergraduates or to physicians. The former it will certainly mislead ; the latter will find but little that they can apply in their own practice. Considering that elavil 50 Dr. Palmer has been for many years a physi- cian and a teacher, and that, consequently, he must have acquired elavil 25 mg experi- ence both as a practitioner and as an instructor, we had a right to expect that his knowledge would be communicated in what he doubtless regards as REVIEWS AND LITERARY NOTES. 597 the crowning work of his life. So far from this expectation being elavil for realized, we find, on the contrary, little or nothing from Dr. Palmer, but a great deal of crude and elementary material badly arranged, and commented upon with indecision and incompleteness. Probably it will sell — such books generally do ; but that the science of medicine will be advanced by its publication no one who wades through it, as we have done, can for a moment believe. And we may add that, if medical students are satisfied to enter upon the practice of their profession with such scanty and erroneous information as they can pick up from books like this, it is no wonder that post-graduate schools and polyclinics are necessary in after-years to teach them the real science and art of medicine. Manual of Gynaecology. By D. Berry Hart, M. D,, F. R. C. P. E., Lec- turer on Midwifery and Diseases of Women, School of Medicine, Edin-

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