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found its way by suction into the vacuum formed by thewater having been turned off. He then went on to pointout the means of preventing this danger, and came to theconclusion that the only true protection would be to admitair into the highest point of house service pipes wheneverthe water was turned off, thus effectively to prevent suctioneither by syphon action or by the formation of a vacuum inthe service-pipes. To effect this he constructed a dome-shaped valve, inside which a float surmounted by an elasticdisc presses against a metallic diaphragm; above the dia-phragm are holes to admit air, so that when the water fallsthe float falls with it, and air is admitted ; when the wateris again turned on, the float rises and seals the valve; thegreater the pressure the more closely the valve is sealed.The objections that have been raised against these valvesare : 1. It is a sanitary fad, and there are plenty of othersin the market. There are certainly some traps, and also anautomatic valve, which entirely failed at Caius College,Cambridge. 2. Why not simply bore a hole in the top of theservice-pipe and so admit air. Truly, such a hole will admitair, but what a splendid fountain would be made with a head,say, of 250 feet of water! 3. What is the necessity of suchvalves when we have separate cisterns for the waterclosets?These often fail, as was the case in the typhoid outbreak atKidderminster. 4. The fear that, unless care is taken to placethe valve where foul air cannot touch it, it would not be of muchuse. To this objection the author stated that it was not in-tended to place the valve under any watercloset, but to keepit at the highest point outside any such place; even were itplaced inside, the air could only act on a very small film ofwater and without any pressure; whereas in suction, air,conveying with it organic matter, passes through a con-siderable quantity of water in the pipes, and all organicimpurity is washed from the air-bubbles into the air.

NORFOLK AND NORWICH MEDICO-CHIRURGICAL SOCIETY.

Suture of the Ulnar Nerve.-At the March meeting of theNorfolk and Norwich Afedico-Chirurgical Society, Dr.MICHAEL BEVERLEY showed a patient whose ulnar nervehe had sutured in November last. H. G. --, aged sixteen,received a severe wound above the left wrist by the burstingof a ginger-beer bottle on August 19th, 1885. When first seenby Dr. Beverley, ten weeks afterwards, the cicatrix was ex-tremely painful, especially if the fingers were extended; therewas complete loss of sensation in the little finger and half ofthe ring finger, both of which drooped, and wasting of themuscles on the outer side of the hand, where the skin wascold and clammy. On November 12th (twelve weeks afterthe injury) Dr. Beverley made an incision along the courseof the ulnar nerve one inch above and below the cicatrix;it was found to be severed; the proximal end was bulbous, andattached by its sheath to the tendon of the flexor carpi ulnaris, ’i,which was itself lacerated by the original injury; hence the ’,pain which was produced by any movement which extended ’this tendon, and thus stretched the sheath by which it was ’,connected to the upper segment of the divided nerve. The ’’,distal end of the nerve was retracted and separated fromthe proximal by nearly half an inch. A fresh section wasmade through the ends of the divided nerve, and they werebrought into accurate opposition by two fine chromicisedcatgut sutures. There was very little tension when thehand was semi-flexed, in which position it was retained by anangular metal splint. The operation was performed undercaroolic spray and with strict antiseptic precautions. Thewound healed by first intention. On the third day afterthe operation there was slight tingling in the little finger,on the sixth day slight sensation to the touch, and on theninth day decidedly returning sensation. On the fourteenthday the hand and arm were thoroughly examined, and itwas found that sensation was partially recovered in all theparts from which it had been absent before the operation.

’ A fortnight later the splint was removed, and the patient wasdirected to use his hand gently; there was a very decidedreturn of sensation, and the drooping fingers could be slightlyraised. The subsequent progress of the case has been verysatisfactory. He can now (March 1st) move the fingersextremely well. Sensation has completely returned, and thehand is of nearly as much use as it was before the accident.In his comments on the case, Dr. Beverley referred toinstances of successful nerve-suturing recorded by Langen-beck, Esmarch, Virchow, Hulke, Heath, and Langton.

Reviews and Notices of Books.Handbook of eo,rap7aical and II/8toriccd ’ECt7scdog2/-. By

Dr. AUGUST HIRSCH. Vol. 2: Chronic, Infective, Toxic,.Parasitic, Septic, and Constitutional Diseases. Trans-lated from the Second German Edition by CHARLES.CBEiGtHTON, l4i.D. London : The New Sydenham Society.1885.

THE subjects contained in this volume of ProfessorHirsch’s classical treatise include many diseases of greatinterest from the historical and geographical standpoint.Leprosy, syphilis, goitre, puerperal fever, and scurvy areamongst the number which are subjected to the penetratinganalysis of the learned author, whose researches have doneso much to complete our knowledge of disease. The scopeof the volume will, however, be best gathered by asummary of the chapters, as follows :- Chronic InfectiveDiseases: (1) Leprosy; (2) Syphilis; (3) Yaws, Button

Scurvy, and Verruga Peruviana; (4) Endemic Goitre andCretinism. Toxic Diseases (5) Ergotism ; (6) Pellagra,and allied diseases; (7) Milk-sickness and the Trembles;(8) Endemic Colic. Parasitic Diseases: (9) Animal Para-sites ; (10) Parasitic Fungi. Infective Tmwnatic Diseases -(11) Erysipelas; (12) Puerperal Fever; (13) Hospital Gan-grene. Chronic Disorders of Nutrition: : (14) Chlorosis.and Anaemia; (15) Scurvy; (16) Beri-beri; (17) Scrofula;.(18) Diabetes; (19) Gout. Although under the term

" leprosy" there has no doubt been included a greatvariety of skin affections, which add to the difficulties ofthe historian to assign a proper value to old chronicles,.there appears to be sufficient evidence of its occurrence in

Egypt, India, and Japan in very remote periods. ProfessorHirsch thinks that the biblical term "saraat" (Leviticus xiii.)probably includes leprosy as well as other affections, as.

psoriasis, scabies, eczema, and perhaps also syphilis. Thesame confusion explains, he thinks, the vast number ofleper houses in Europe in the middle ages, for althoughtrue leprosy was probably then endemic, it is hardly con-ceivable that it should have prevailed so largely, especiallyas we have in syphilis a far more probable explanation ofthe vast increase in cutaneous disease which coincided withthe Crusades. At the present day endemic leprosy is verycircumscribed in Europe; it occurs in parts of Spain andPortugal, in Italy, on the Gulf of Genoa and the Adriatic,.in Sicily (where it has been on the increase), in Greece, andespecially in Crete; whilst it has died out in Roumania,Hungary, and Southern Russia, and has gradually decreasedin Sweden, but prevails, as is well known, in Norway andin Iceland. Its distribution in other parts of the globe istoo diffuse to summarise, but there is ample evidence thatclimatic and soil conditions are not the sole factors favour--

ing it. The influence of a diet of fish, especially of

putrid fish, which has been so staunchly maintained byHutchinson, is discussed by Hirsch, who concludes that thetheory is one-sided and untenable. The proofs in favourof a specific infective virus which have accumulatedwithin the past ten years give all such speculations asto the operation of dietetic, hygienic, and climatic influ-ences a subsidiary importance. The question of the con-tagiousness of leprosy is met by Hirsch with many factsshowing how little there is to support it, whilst the transmis-sion of an inherited predisposition is thoroughly established.That the disease can be acquired by Europeans who residein leprous localities abroad is also established, and it isremarkable that a few cases have so arisen in "regions whereleprosy as an endemic had been extinct for centuries." As

with leprosy, so with syphilis; ancient writings afford evidenceenough of its existence in the earliest times, but there is no Iquestion that about the end of the fifteenth century a great Iepidemic overran Europe. Some curious facts respecting I