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and has to wait a while before he can accomplish any muscular movement. He usually succeeds Levitra Price Increases after making a third attempt. He has no pain at these times, but, as Levitra Price Increases he expresses Levitra Price Increases it, Levitra Price Increases everything all Levitra Price Increases at once tightens in his muscles when he tries to move, and he has to wait Levitra Price Increases till they get ready to let him use them. This is repeated every day. He also has fixed spasm without pain at other times, after the muscles have been long quiescent, on sud- denly attempting motion, but Levitra Price Increases not every day. The only daily phenomenon of this kind is in the early morning. He has no unconscious seizures. His appetite is fair. His urine is normal to .ilbumin and sugar tests and to litmus. The eyes have been examined ophthalinoscopically, but nothing was elicited. The patient's age is thirty-six years. He is an American by birth, without cerebro-spinal neuropathic heredity, and a farm- er by occupation. I have lately also seen Thomsenean contracture in a case of cerebellar disease with lateral movement of the sterno- mastoid, becoming rigid on the person suddenly attempting to move round or flex the head. 3000 Chestnut Street, St. Louis. A CASE OF DOUBLE VAGINA AND DOUBLE UTEEUS. By ALFRED C. PALMER, M. D., RICHMOND, TA., On May 25, 188.5, I was called to see Mrs. S., aged twenty- three, who has been married two years. She had been suffer- ing from pains in the back and lower part of the abdomen for the past year. In answer to questions propounded, I ascer- tained that she had menstruated at the age of fifteen, and had been regular up to a year previous to the time I first saw Levitra Price Increases her. At this period she had miscarried after two months' pregnancy, since which time she had suffered from pains during menstrua- tion, which now lasted from eight to ten days, and were fol- lowed by leucorrhcea. Upon making my first examination I found an .ilmost healthy uterus, and was surprised that my pa- tient complained of so much diwomfort. I made an apphcatiou to the cervical canal, and advised vaginal injections of warm water. At ray next visit, upon introducing a bivalve speculum, an entirely different condition of things presented itself Here was a uterus considerably engorged, with the cervix slightly lacerated, and emitting a very tenacious discharge, indicating considerable cervjco- endometritis. Much astonished at the ap- parent ch.ange in the appearance of the parts, I withdrew the bivalve, and introduced a Sims's speculum foi' further examina- tion. Upon retracting the perinajum, there came into view an almost healthy uterus, which I recognized as the one seen at my first visit. Further investigation disclosed what appeared to be an opening in the wall of the vagina, immediately inside of the external orifice, which presented the appearance of an excava- tion produced by an ulcer that bad entirely healed. Introduc- July 17, 1886.] BOOK NOTICES. 71 ing my finger to explore the depth of this excavation, I found that it passed np without difficulty, feeling the blade of my speculum through a rather thick membranous partition. Fur- ther inserting my finger, I distinctly felt an os uteri, at the same time having another fully in sight, disclosed by the specu- lum. The diagnosis was easy. With the assistance of my friend Dr. George Levitra Price Increases Ross, at my next visit a Levitra Price Increases more thorough ex- amination was made. We discovered two perfectly formed vaginfe, with a partition about three lines in thickness entirely separating them. This partition began between the two necks of the uteri, and passed downward to the external vaginal ori- fice, the rugfB being perfect upon its sides. The uteri lay in a lateral position, miscarriage having occurred in the one upon the right side from the appearances presented. Introducing a probe, we found the two entirely distinct, the one upon the left measuring Levitra Price Increases one inch and three quarters, the right two inches and a quarter in depth. Subsequent investigation showed that menstruation took place in both at the same time, continuing a Levitra Price Increases little longer in the right. l3ooh ftottres. Diseases of the Tongue. By Henet T. Butlin, F. R. C. S., As- sistant Surgeon and Demonstrator of Practical Surgery and Diseases of the Larynx, St. Bartholomew's Hospital, etc. Illustrated with Chromo-lithographs and Engravings. Phila- delphia: Lea Brothers & Co., 1885. Pp. viii-iSl. The author informs us in his preface Levitra Price Increases that " for years he has made Levitra Price Increases use of the opportunities which the large out-patient de- partment of St. Bartholomew's Hospital has afforded in study- ing and making drawings of disease of the tongue," and that this volume Levitra Price Increases is the outcome of his experience in this subject. Diseases of the tongue are treated of in twenty-four chapters as follows: After .some introductory remarks in which the plan of the work is explained, he begins in Chapter I with the consid- eration of accidents to the tongue. Then follow those on con- genital defects, discoloration of the tongue, inflammation of the substance of the tongue, eruptions on the tongue, indentations, •excoriations, furrows and fissures of this organ, ulcers of the tongue, patches and plaques, nodes and nodules, smooth patches and smooth tongues, atrophy, hypertrophy, cysts of the tongue, ■cysts under the tongue and salivary calculus, innocent tumors, cancer, treatment of cancer of the tongue by operation, causes of death after removal of the tongue, after-treatment of opera- tions, Levitra Price Increases the choice of an operation, later operations on the lym- phatic glands, later operation? for recurrent disease, palliative treatment, parasitic affections, and an appendix containing a list of works and papers referring to the subjects treated of in the book. In each of these chapters the subject Levitra Price Increases is thoroughly consid- ered, and that in a very practical manner. To mention all that is worthy of Levitra Price Increases remark would far exceed the bounds of this notice. The consideration of tumors of this organ occupies more space than that of any other of the subjects treated of. In regard to malignant disease, the author calls attention to the pre-cancerous stage, and insists that any condition of the tongue liable to de- generate into malignant disease should receive early attention, and that all substances irritating to the mucous membrane should be avoided. Smoking, provided it causes any irritation, should be prohibited. He states that if there is one thing more harmful than another in the treatment of simple indolent ulcers of the mouth, it is the application of strong caustic. He points