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AN UNUSUAL CASE OF PROLONGED FEVER PRESENTING ACUTE HEPATIC CHANGES.
25 and of mind.
approaching
all blood
problems
with
an
unbiassed1
As the journal in which the above-mentioned article appears is not likely to be seen by the majority of those) interested I thought it well to direct attention to it in your .columns, especially as I have been able to confirm the findings and as my first paper on the subject appeared in THE LANCET. lihartomn.
ULTRA-VIOLET LIGHT IN THE TREATMENT OF ALOPECIA. HARRIS, M.D. DURH., M.R.C.S. ENG.,
BY J. DELPRATT
quite six months she has just now returned with one or two areata patches. It would seem from the report of Dr. Kromayer and the above that this form of treatment is quite worthy of an extended trial.
Exeter. AN
UNUSUAL CASE OF PROLONGED FEVER PRESENTING ACUTE HEPATIC CHANGES. BY H. GWYNNE LAWRENCE, M.B. LOND.
THE subject of the following notes was under observation for ten months. For the first six months he presented very HONORARY MEDICAL OFFICER IN CHARGE OF THE ELECTRICAL DEPART- little in the way of physical signs, although throughout this MINT OF THE ROYAL DEVON AND EXETER HOSPITAL. period he was the subject of marked fever, at first intermittent with definite periods of apyrexia, but latterly THE ultra-violet light made use of in the following cases and finally continuous. remittent, from iron electrodes between which sparks were was obtained The aged 62 years, 15 years ago resided in India discharging from an oil condenser attached to a 10-inch coil for fivepatient,without years any detriment. Two years ago he had actuated by 24-volt accumulator batteries giving 5 to 7 an attack of tachycardia which passed off in a short period, in the coil ampères primary. and for three years he had suffered from an annual febrile The plan of treatment was practically that recommended attack believed to be influenza. No evidence was obtainable but Dr. as the current available for this treatKromayer, by of alcoholic or dietetic excesses. The only other important ment was so small the sittings were much prolonged and detail upon which he laid much stress was the fact that all each place was subjected to half an hour’s exposure. The his life any form of aperient upset him profoundly, as did also skin was separated from the quartz compressor by solid ice enemata. For the first six months symptoms other than could cut in squares of convenient size, about three-quarters of an be attributed to the fever were completely absent. During inch thick. It was renewed as often as it melted, and the the last four months clinical signs of cirrhosis of the liver metallic oxide on the inner surface of the quartz wiped away In the earliest days a bad night would be followed at the same time. Good reaction with peeling of the skin appeared. a tongue thickly coated with a brown moist fur, the breath followed, the hyperæmia lasting a week as a rule, but by would be "heavy," the skin dry and hot, the face slightly A second was not administration occasionally longer. given and occasionally some flatulent distension of until most of the hyperæmia had disappeared. In the yellow-tinted, the colon could be recognised. The temperature rose at ctotalis cases tracts were chosen for treatment that could 6 P.M. daily to 1020 F., or rather higher, and was at the again be found easily, such as the frontal, parietal, or normal line again at 6 A.M. This continued for a period of occipital tract corresponding to the bones of those names. from 10 to 14 days, when a similar period of apyrexia When the tract became painfully hyperæmic it was given and the patient became comfortable, and the occurred, rest, whilst another was similarly treated. When the hair cleaned to a great extent, but not absolutely. began to grow the treatment was still continued until it tongue features at the height of the fever were the Conspicuous became about half an inch long. In the areata cases it was facts that the pulse was little disturbed and rarely exceeded - noticed that the hair usually spread in from the periphery 62 in frequency, and that the respirations remained at 20 to towards the centre, so that the space became gradually 24. The skin was hot and dry, the bowels acted well or .smaller. required gentle stimulation, and no after-symptomsMany of the cases were long and tedious ones which had only &c.-were headache, experienced. e.g., undergone topical treatment with all the usual remedies The Blood examinations showed a marked leucopenia. before coming to the electrical department. It was conred cells were practically normal in amount, with some sidered advisable to continue a mercurial lotion and an deterioration in haemoglobin; white cells 2300 per acetic acid lotion unless they caused irritation. These tests toenteric and Mediterranean lotions were regarded in the nature of a placebo for the c.mm. Agglutination fever were negative, as was also Wassermann’s reaction. not be treated by means of Blood cultures proved negative on all occasions. Treatment portions of the scalp which could the ultra-violet light rays. The cases treated were nine in was directed against pyorrhoea alveolaris which was present, number, as follows :but only temporary improvement of this condition occurred, and the course of the main disease was absolutely uninfluenced. This state continued for six months. The liver became gradually more and more displaced upwards by the abdominal distension, the upper margin eventually reaching the fifth rib in the vertical nipple line. During this period occasionally a slimy mucous stool, offensive in character, was passed, and an occasional attack of short duration of tachycardia occurred. In the apyrexial period the appetite was good, the general nutrition improved, and there was a complete absence of symptoms. At the sixth month ascites began to develop and the abdominal distension was a continuous feature. The base of the right lung showed signs of compression ; the skin became yellowish in tint and showed loss of elasticity. The evidence at this period, from a clinical point of view, suggested the cardinal signs of cirrhosis of the liverjaundice, ascites, and a liver apparently (by X ray examinaCase 6 should be regarded as eurecl, for the hair, which tion) of normal contour, but rather smaller than normal. had been quite at a standstill, began to grow almost directly With this the spleen could be felt at the rib margin, and this treatment was commenced. She was anxious to go some discomfort was experienced over the splenic area. At home. Case 7 was one of those in which alopecia seems to this stage the blood cultures again proved negative and the follow ringworm. On commencing the treatment the hairleucocyte count amounted to 1716 per c. mm. The diSerential began to grow, to the great relief of the parents, who fearedcount was : polymorphonuclear, 41 per cent. ; mononuclear, permanent patchy baldness. No X rays had been used.25 per cent. ; lymphocytes, 32-62 per cent. ; eosinophiles, Case 9 was the most striking of all, being total to the scalp1’ 38 per cent. For a short interval acute pain was experionly. The eyebrows and lashes were never completely lost, enced at the point of the left shoulder, in the region supplied nor the armpit or pubic hair at all, yet her scalp became 1by the fourth cervical nerve. clothed with thick and long hair. After remaining well for For the last two months the temperature remained
26 constant, generally reaching 103° at 6 P.M. The pulse was little affected as regards frequency until cardiac weakness appeared in the last few weeks. Fæcal examinations showed an unusual number of microbic elements and an unusual type of coliform bacillus, but the food elements were Pathology, General and Special, for Students of Medicine; digested. In the later periods fats were not digested and By R. TANNER HEWLETT, M.D. Lond., F.R.C.P. Lond., bile was deficient. Urobilin was in excess in the urine. D. P. H. R.C.P.S., Professor of Bacteriology in the UniverIntestinal antiseptics-e.g., salol, parattin, &c.-were sity of London. Third edition. London : J. and A.. administered from the start, but produced no benefit. Churchill. Pp. 610. Price 10s. 6d. net. Necropsy.-A post-mortem examination by Dr. B. H. Dr. Hewlett’s Pathology, General and Special," bears; Spilsbury showed the following condition :-External.- on its title page the modest claim for students of’ There was some oedema of the lower extremities and scrotum. The abdomen was rather distended. Intergral.-Heart :All medicine." It is no easy task, even when a volume, handy cavities dilated. Muscle showed microscopically marked in form and well printed, reaches a third edition, to give a, brown atrophy. Lungs : Partly compressed by diaphragm. concise account of such an extensive subject as modern They also showed passive congestion and emphysema. pathology in all its aspects. The author in the text has, we Peritoneum contained 3 to 5 pints of clear ascitic fluid. Liver : Of about nolmal size, but increased weight. There think, struck the happy mean for a student’s text-book. Most medical students are content with such a knowledgewas some surface irregularity, but little thickening of and The the was firm On section of this subject as will aid them in the art of healing. In very dry. capsule. organ cut surface had a mottled appearance, reddish and grey areas medical schools, as a rule, a certain portion of one year only alternating. The organ did not appear greasy. No fibrous is given to acquiring a knowledge of this subject. In some. network could be detected with certainty. The gall-bladder room work bulks more largely than the Bile- cases post-mortem was normal and contained a pale and watery bile. ducts normal. Microscopically the organ is traversed by actual pathological vital changes that accompany disease. These facts have dictated the scope of the work. numerous broad, and in places interlacing, areas in which the liver cells are undergoing atrophy and many have dis- Professor Hewlett has made free use of the ordinary textappeared, the wide spaces between the cells being books in English, while in the text there are footnote occupied by greatly dilated blood capillaries (which are references to certain papers in the journals, practically all not easily seen owing to post-mortem changes). In the meshes of this interlacing network are islands of liver English. It may be taken that the average student does cells which exhibit marked hypertrophic changes, the not refer to the French or German books or papers on cells being of large size and staining deeply, and some this subject, so that the introduction of foreign references; having two nuclei apiece. These changes are not very can well be spared. regularly disposed, but the atrophic areas appear to be Five years have elapsed since the second edition was chiefly in the central, and the hypertrophic chiefly in the and much progress has been made, and conseissued, peripheral, zones of the lobules. All the liver cells contain some excess of pigment. infiltration is exhibited Fatty by quently the treatment of such subjects as the etiology some of the hypertrophied cells, but the atrophied cells conof neoplasms, immunity, the ductless glands.paroxysmal tain no fat. There is a little recent fibrous thickening of the hæmoglobinuria and epidemic poliomyelitis has been capsule, but none of the portal areas except around some of enlarged, while new sections have been added on the the larger bile-ducts ; there is, however, some thickening of the walls of the hepatic vein tributaries. There is no Wassermann reaction, complement fixation, and anaphymyxomatous degeneration in the organ. There is practically laxis. But the general scope and arrangement of the work no round-celled infiltration of the organ, and nothing to are the same as in the previous editions. The illustrations, suggest an infective process. There is no true cirrhosis or which are all in black and white and of microscopical biliary cirrhosis, but a widespread atrophy associated with subjects, are presented in 32 plates and some figures in processes of compensatory hypertrophy-a condition of sub- the text, while the text is arranged in 19 chapters, which do’ acute hepatitis probably of toxic origin. Spleen : Much enlarged, about 20 oz. in weight. not seem to follow any very logical order-for example, the: Microscopically it showed advanced passive congestion. ductless glands and internal secretions take a comparatively Smears from the spleen were examined for micro-organisms early place, while Mendelism is introduced on the third page.. and malarial parasites, but without success. The blood in Is the statement on p. 90 as to the relation between a sharp, the organ showed, however, very marked anagmic changes of knife and union by first intention a complete: clean, aseptic the red corpuscle with numerous nucleated red cells. statement of truth ?2 We think not. What about the conUrine but Somewhat highly Kidneys : enlarged, healthy. As to Mediterranean fever,. dition of the skin incised ?‘! coloured. Other abdominal organs normal. The clinical features of a marked rise in temperature, the author’s account of its pathology seems to point. remittent in type, and a definite leucopenia with evidences to no practical result. Bernard did not forget to state, of gastro-intestinal catarrh, made a diagnosis uncertain as the author does, the importance of previous feeding: during the early stages owing to the conspicuous fever pre- with carbohydrates in his famous piqûre experiment. sent. The acute destruction of liver cells and the condition of acute cirrhosis make it of particular interest pathologi- In connexion with the pituitary body we miss Ott’s: cally. Investigations of a most thorough nature by Dr. T. J. observation on its action as a galactagogue. Instead Horder and Dr. J. Matthews failed to find any bacterial of "comparatively recently,why not give the exact dateinfection in the blood during the various stages, and possibly when the relation between the pancreas and diabetes; we should be right, in view of the slight constitutional disturbance apart from temperature, in regarding the poison as was discovered by experiment? Gley’s name seems to be omitted in connexion with the thyroid and parathyroids,. being of a chemical nature. Green-street, W. nor did we find a reference to Chalmers Watson’s work. It should be made clear which of the gases of the bloocf MEMORIAL TO MISS ROSA MORISON.-The escapes during too rapid decompression in caisson disease. We have cited a few directions in which we think that in. friends of the late Miss Rosa Morison (lady superintendent future editions Professor Hewlett might improve his work,. of women students at University College, London, raise as a tribute of the desire to a memorial not with 1883-1912), any desire to be captious, but because it is such a. affection and respect in which they held her, and as a means good book. He has given a readable condensed epitomeof commemorating her work in connexion with the higher of his subject largely as it is seen through English eyes, education of women. Those who wish to take part in this and the scope of the work is so exactly what should memorial should communicate with the honorary secretaries, to practical teachers that it would be worth while Rosa Morison Memorial Committee, University College, appeal to remove all small blemishes as far as possible.
Reviews and Notices of Books.
Gower-street, London, W.C.
approaching
all blood
problems
with
an
unbiassed1
As the journal in which the above-mentioned article appears is not likely to be seen by the majority of those) interested I thought it well to direct attention to it in your .columns, especially as I have been able to confirm the findings and as my first paper on the subject appeared in THE LANCET. lihartomn.
ULTRA-VIOLET LIGHT IN THE TREATMENT OF ALOPECIA. HARRIS, M.D. DURH., M.R.C.S. ENG.,
BY J. DELPRATT
quite six months she has just now returned with one or two areata patches. It would seem from the report of Dr. Kromayer and the above that this form of treatment is quite worthy of an extended trial.
Exeter. AN
UNUSUAL CASE OF PROLONGED FEVER PRESENTING ACUTE HEPATIC CHANGES. BY H. GWYNNE LAWRENCE, M.B. LOND.
THE subject of the following notes was under observation for ten months. For the first six months he presented very HONORARY MEDICAL OFFICER IN CHARGE OF THE ELECTRICAL DEPART- little in the way of physical signs, although throughout this MINT OF THE ROYAL DEVON AND EXETER HOSPITAL. period he was the subject of marked fever, at first intermittent with definite periods of apyrexia, but latterly THE ultra-violet light made use of in the following cases and finally continuous. remittent, from iron electrodes between which sparks were was obtained The aged 62 years, 15 years ago resided in India discharging from an oil condenser attached to a 10-inch coil for fivepatient,without years any detriment. Two years ago he had actuated by 24-volt accumulator batteries giving 5 to 7 an attack of tachycardia which passed off in a short period, in the coil ampères primary. and for three years he had suffered from an annual febrile The plan of treatment was practically that recommended attack believed to be influenza. No evidence was obtainable but Dr. as the current available for this treatKromayer, by of alcoholic or dietetic excesses. The only other important ment was so small the sittings were much prolonged and detail upon which he laid much stress was the fact that all each place was subjected to half an hour’s exposure. The his life any form of aperient upset him profoundly, as did also skin was separated from the quartz compressor by solid ice enemata. For the first six months symptoms other than could cut in squares of convenient size, about three-quarters of an be attributed to the fever were completely absent. During inch thick. It was renewed as often as it melted, and the the last four months clinical signs of cirrhosis of the liver metallic oxide on the inner surface of the quartz wiped away In the earliest days a bad night would be followed at the same time. Good reaction with peeling of the skin appeared. a tongue thickly coated with a brown moist fur, the breath followed, the hyperæmia lasting a week as a rule, but by would be "heavy," the skin dry and hot, the face slightly A second was not administration occasionally longer. given and occasionally some flatulent distension of until most of the hyperæmia had disappeared. In the yellow-tinted, the colon could be recognised. The temperature rose at ctotalis cases tracts were chosen for treatment that could 6 P.M. daily to 1020 F., or rather higher, and was at the again be found easily, such as the frontal, parietal, or normal line again at 6 A.M. This continued for a period of occipital tract corresponding to the bones of those names. from 10 to 14 days, when a similar period of apyrexia When the tract became painfully hyperæmic it was given and the patient became comfortable, and the occurred, rest, whilst another was similarly treated. When the hair cleaned to a great extent, but not absolutely. began to grow the treatment was still continued until it tongue features at the height of the fever were the Conspicuous became about half an inch long. In the areata cases it was facts that the pulse was little disturbed and rarely exceeded - noticed that the hair usually spread in from the periphery 62 in frequency, and that the respirations remained at 20 to towards the centre, so that the space became gradually 24. The skin was hot and dry, the bowels acted well or .smaller. required gentle stimulation, and no after-symptomsMany of the cases were long and tedious ones which had only &c.-were headache, experienced. e.g., undergone topical treatment with all the usual remedies The Blood examinations showed a marked leucopenia. before coming to the electrical department. It was conred cells were practically normal in amount, with some sidered advisable to continue a mercurial lotion and an deterioration in haemoglobin; white cells 2300 per acetic acid lotion unless they caused irritation. These tests toenteric and Mediterranean lotions were regarded in the nature of a placebo for the c.mm. Agglutination fever were negative, as was also Wassermann’s reaction. not be treated by means of Blood cultures proved negative on all occasions. Treatment portions of the scalp which could the ultra-violet light rays. The cases treated were nine in was directed against pyorrhoea alveolaris which was present, number, as follows :but only temporary improvement of this condition occurred, and the course of the main disease was absolutely uninfluenced. This state continued for six months. The liver became gradually more and more displaced upwards by the abdominal distension, the upper margin eventually reaching the fifth rib in the vertical nipple line. During this period occasionally a slimy mucous stool, offensive in character, was passed, and an occasional attack of short duration of tachycardia occurred. In the apyrexial period the appetite was good, the general nutrition improved, and there was a complete absence of symptoms. At the sixth month ascites began to develop and the abdominal distension was a continuous feature. The base of the right lung showed signs of compression ; the skin became yellowish in tint and showed loss of elasticity. The evidence at this period, from a clinical point of view, suggested the cardinal signs of cirrhosis of the liverjaundice, ascites, and a liver apparently (by X ray examinaCase 6 should be regarded as eurecl, for the hair, which tion) of normal contour, but rather smaller than normal. had been quite at a standstill, began to grow almost directly With this the spleen could be felt at the rib margin, and this treatment was commenced. She was anxious to go some discomfort was experienced over the splenic area. At home. Case 7 was one of those in which alopecia seems to this stage the blood cultures again proved negative and the follow ringworm. On commencing the treatment the hairleucocyte count amounted to 1716 per c. mm. The diSerential began to grow, to the great relief of the parents, who fearedcount was : polymorphonuclear, 41 per cent. ; mononuclear, permanent patchy baldness. No X rays had been used.25 per cent. ; lymphocytes, 32-62 per cent. ; eosinophiles, Case 9 was the most striking of all, being total to the scalp1’ 38 per cent. For a short interval acute pain was experionly. The eyebrows and lashes were never completely lost, enced at the point of the left shoulder, in the region supplied nor the armpit or pubic hair at all, yet her scalp became 1by the fourth cervical nerve. clothed with thick and long hair. After remaining well for For the last two months the temperature remained
26 constant, generally reaching 103° at 6 P.M. The pulse was little affected as regards frequency until cardiac weakness appeared in the last few weeks. Fæcal examinations showed an unusual number of microbic elements and an unusual type of coliform bacillus, but the food elements were Pathology, General and Special, for Students of Medicine; digested. In the later periods fats were not digested and By R. TANNER HEWLETT, M.D. Lond., F.R.C.P. Lond., bile was deficient. Urobilin was in excess in the urine. D. P. H. R.C.P.S., Professor of Bacteriology in the UniverIntestinal antiseptics-e.g., salol, parattin, &c.-were sity of London. Third edition. London : J. and A.. administered from the start, but produced no benefit. Churchill. Pp. 610. Price 10s. 6d. net. Necropsy.-A post-mortem examination by Dr. B. H. Dr. Hewlett’s Pathology, General and Special," bears; Spilsbury showed the following condition :-External.- on its title page the modest claim for students of’ There was some oedema of the lower extremities and scrotum. The abdomen was rather distended. Intergral.-Heart :All medicine." It is no easy task, even when a volume, handy cavities dilated. Muscle showed microscopically marked in form and well printed, reaches a third edition, to give a, brown atrophy. Lungs : Partly compressed by diaphragm. concise account of such an extensive subject as modern They also showed passive congestion and emphysema. pathology in all its aspects. The author in the text has, we Peritoneum contained 3 to 5 pints of clear ascitic fluid. Liver : Of about nolmal size, but increased weight. There think, struck the happy mean for a student’s text-book. Most medical students are content with such a knowledgewas some surface irregularity, but little thickening of and The the was firm On section of this subject as will aid them in the art of healing. In very dry. capsule. organ cut surface had a mottled appearance, reddish and grey areas medical schools, as a rule, a certain portion of one year only alternating. The organ did not appear greasy. No fibrous is given to acquiring a knowledge of this subject. In some. network could be detected with certainty. The gall-bladder room work bulks more largely than the Bile- cases post-mortem was normal and contained a pale and watery bile. ducts normal. Microscopically the organ is traversed by actual pathological vital changes that accompany disease. These facts have dictated the scope of the work. numerous broad, and in places interlacing, areas in which the liver cells are undergoing atrophy and many have dis- Professor Hewlett has made free use of the ordinary textappeared, the wide spaces between the cells being books in English, while in the text there are footnote occupied by greatly dilated blood capillaries (which are references to certain papers in the journals, practically all not easily seen owing to post-mortem changes). In the meshes of this interlacing network are islands of liver English. It may be taken that the average student does cells which exhibit marked hypertrophic changes, the not refer to the French or German books or papers on cells being of large size and staining deeply, and some this subject, so that the introduction of foreign references; having two nuclei apiece. These changes are not very can well be spared. regularly disposed, but the atrophic areas appear to be Five years have elapsed since the second edition was chiefly in the central, and the hypertrophic chiefly in the and much progress has been made, and conseissued, peripheral, zones of the lobules. All the liver cells contain some excess of pigment. infiltration is exhibited Fatty by quently the treatment of such subjects as the etiology some of the hypertrophied cells, but the atrophied cells conof neoplasms, immunity, the ductless glands.paroxysmal tain no fat. There is a little recent fibrous thickening of the hæmoglobinuria and epidemic poliomyelitis has been capsule, but none of the portal areas except around some of enlarged, while new sections have been added on the the larger bile-ducts ; there is, however, some thickening of the walls of the hepatic vein tributaries. There is no Wassermann reaction, complement fixation, and anaphymyxomatous degeneration in the organ. There is practically laxis. But the general scope and arrangement of the work no round-celled infiltration of the organ, and nothing to are the same as in the previous editions. The illustrations, suggest an infective process. There is no true cirrhosis or which are all in black and white and of microscopical biliary cirrhosis, but a widespread atrophy associated with subjects, are presented in 32 plates and some figures in processes of compensatory hypertrophy-a condition of sub- the text, while the text is arranged in 19 chapters, which do’ acute hepatitis probably of toxic origin. Spleen : Much enlarged, about 20 oz. in weight. not seem to follow any very logical order-for example, the: Microscopically it showed advanced passive congestion. ductless glands and internal secretions take a comparatively Smears from the spleen were examined for micro-organisms early place, while Mendelism is introduced on the third page.. and malarial parasites, but without success. The blood in Is the statement on p. 90 as to the relation between a sharp, the organ showed, however, very marked anagmic changes of knife and union by first intention a complete: clean, aseptic the red corpuscle with numerous nucleated red cells. statement of truth ?2 We think not. What about the conUrine but Somewhat highly Kidneys : enlarged, healthy. As to Mediterranean fever,. dition of the skin incised ?‘! coloured. Other abdominal organs normal. The clinical features of a marked rise in temperature, the author’s account of its pathology seems to point. remittent in type, and a definite leucopenia with evidences to no practical result. Bernard did not forget to state, of gastro-intestinal catarrh, made a diagnosis uncertain as the author does, the importance of previous feeding: during the early stages owing to the conspicuous fever pre- with carbohydrates in his famous piqûre experiment. sent. The acute destruction of liver cells and the condition of acute cirrhosis make it of particular interest pathologi- In connexion with the pituitary body we miss Ott’s: cally. Investigations of a most thorough nature by Dr. T. J. observation on its action as a galactagogue. Instead Horder and Dr. J. Matthews failed to find any bacterial of "comparatively recently,why not give the exact dateinfection in the blood during the various stages, and possibly when the relation between the pancreas and diabetes; we should be right, in view of the slight constitutional disturbance apart from temperature, in regarding the poison as was discovered by experiment? Gley’s name seems to be omitted in connexion with the thyroid and parathyroids,. being of a chemical nature. Green-street, W. nor did we find a reference to Chalmers Watson’s work. It should be made clear which of the gases of the bloocf MEMORIAL TO MISS ROSA MORISON.-The escapes during too rapid decompression in caisson disease. We have cited a few directions in which we think that in. friends of the late Miss Rosa Morison (lady superintendent future editions Professor Hewlett might improve his work,. of women students at University College, London, raise as a tribute of the desire to a memorial not with 1883-1912), any desire to be captious, but because it is such a. affection and respect in which they held her, and as a means good book. He has given a readable condensed epitomeof commemorating her work in connexion with the higher of his subject largely as it is seen through English eyes, education of women. Those who wish to take part in this and the scope of the work is so exactly what should memorial should communicate with the honorary secretaries, to practical teachers that it would be worth while Rosa Morison Memorial Committee, University College, appeal to remove all small blemishes as far as possible.
Reviews and Notices of Books.
Gower-street, London, W.C.