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of naso-pharyngeal polypi are especially noticeable. A chapter on Tenotomy, which is possibly fuller, and certainly clearer, than that in any other text-book of operative surgery, concludes the first volume.

Volume II. begins with a section on Plastic Surgery, and includes various operations for bare-lip, rhinoplasty, cleft-palate, hypospadius and epispadius, etc. In hare-lip the usual operation, as performed in this country, is recommended--the paring of the edges of the cleft with a knife and the formation of an angle with its apex outward at the lower extremity of the wound being advised. The approximation, however, is effected by means of silkworm-gut sutures, hare-lip pins being objected to for fear of sloughing of the part of the wound lying beneath the figure-of-8 ligature and of permanent cicatrices from the pins.

In exstrophy of the bladder, Thiersch's method, by two lateral flaps, is the one preferred, as it is thought to be more in accord with the principles of modern plastic surgery than the method of Wood. Maury's operation, by which the flap is taken from the scrotum, is described with the remark that the tissues of the scrotum have been shown to be not well adapted for the substance of the principal or primary flap. Trendelenburg's operation of narrowing the defective area by approximating the two innominate bones by separation of the sacro-iliac synchondroses is fully described, but its value is thought to be still undetermined.

In the section on the Neck, which contains an admirable description of the dangers and difficulties of tracheotomy, thyrotomy, and laryngectomy, especial attention has been paid to the details of the operation for excision of scrofulous glands. The writings of Mr. Treves, and of his brother, Mr. William Knight Treves, of Margate, upon this subject are now well known, but we believe that this is the first time that a formal description of this operation has been included in a systematic text-book.

The section upon the Abdomen is especially full and complete, and the intestinal operations are described with the thoroughness and clearness that might be expected from one who has given the subject the study and attention which it has received from Mr. Treves. The various forms of intestinal anastomosis and intestinal suture are described with great minuteness. Among the latter the right-angle continuous suture is thought to be the best of that variety, while among the interrupted sutures Lembert's is said to have stood the test of time and to be, on the whole, the best form of suture with which we are acquainted, on account of its extreme simplicity, the rapidity with which each stitch can be inserted, and its undoubted efficacy.

In hysterectomy Mr. Treves adheres to his well-known position as to ligation of the ovarian and uterine arteries, believing that this can be done with certainty in the great majority of cases.

We observe that in describing Loreta's operation Mr. Treves suggests that in cases of recent stricture of the pylorus due to the swallowing of caustics, the operation should be postponed until the symptoms of ulceration of the stomach have passed away, and that the stomach should then be opened and a temporary gastric fistula established through which the stricture might be gradually dilated.

After a description of the best-known methods for the radical cure of hernia, Mr. Treves adds that it would be impossible at present to attempt to form any conclusion as to the value of one method as compared with another merely from the statistics of the various operations which have from time to time been published. It is acknowledged that the term



“ radical cure" is possibly a little too ambitious, and it has had to be pointed out by every operator that the methods employed are not infallible. Still, every year that passes gives to these measures a better claim to the title with which they have been associated from their beginning.

In the article on Supra-pubic Lithotomy, Mr. Treves says that the practice observed by some of not distending the rectal bag until the bladder has been reached has much to commend it. Experiments upon the cadaver seem to show, however, that the best results are obtained, so far as the projection forward of the bladder is concerned, when the rectum is distended first and the bladder afterward.

He alludes to the objections to litholapaxy in male children, namely, the smallness of the bladder, the delicate character of the mucous membrane, the narrowness of the urethra, and the great success of lithotomy; but adds that Keegan has demonstrated their fallacy, and has made it evident that litholapaxy offers an excellent means of treating stone in children. He agrees, however, with the opinion expressed by Keegan that no one should attempt to perform litholapaxy in boys until he has first gained some experience of the operation in male adults.

Mr. Treves's method of treating prolapse of the rectum by excision; the operation which is known by his name for reaching the bodies of the lumbar vertebra ; his plan of treating psoas abscess, which he irrigates, sponges out carefully, dries, and closes without drainage, are all described with great fulness; but the limits of this review forbid other than passing notice. As to operations upon the spine, he remarks that as to traumatism, the case operated on by Macewen in 1885 marks a pew era, and that since then a large number of successful cases have been reported. He refers also to the high percentage of improvement which has followed operations in Pott's paralysis. In his description of the operation of resection of the spine, he states that he has followed closely the method advocated by White.

The book concludes with an excellent chapter on Removal of the Breast.

When compared with other books written on parallel lines, we think it safe to say that this is at once the most comprehensive, and, at the same time, the most clear and concise manual of operative surgery which bas been written in modern times. We have compared it carefully with all the best known works of a similar character, and we have found that for precision and fulness of anatomical detail, for careful description of each successive step of the operation, for attention to all the collateral issues involved, particularly the after-treatment of the operative wound and of the patient, for judicial weighing of the advantages and disadvantages of each operative method, and for good judgment in the selection of the one finally recommended as the best, it is, in our opinion, to be preferred to any previous work on this subject.

The candor shown in this book, which is one of Mr. Treves's characteristics in all his work, is also to be noted and commended. When he has not himself done an operation he says so, and gives the grounds, whatever they may be, for the opinion which he has expressed in reference to it. In many directions, as the book shows, he has had a most extensive personal experience to draw upon, and on some subjects, as, for example, that of intestinal obstruction, his opinions may fairly be said to rank with those of the first surgical authorities in Europe. . We can well believe that this work has taken, as he states in the preface, all his leisure time


for the last four years; but we can congratulate him on having produced a book which is a distinct addition to the surgical literature of our time, which will prove to be indispensable to every practical surgeon, and for which we predict a hearty and widespread approval on the part of the profession.

J. W. W.


BY THE HYPODERMATIC OR SUBCUTANEOUS METHOD. By ROBERTS BARTHOLOW, A.M., M.D., LL.D., Emeritus Professor of Materia Medica, General Therapeutics, and Hygiene in the Jefferson Medical College of Philadelphia, etc. Fifth edition, revised and enlarged. Philadelphia: J. B. Lippincott Company, 1891.

The fifth edition of this work has grown to a book of 540 pages, as many of the articles have been rewritten and new matter has been added. An interesting historical sketch of the hypodermatic method begins the work. The author uses the term hypodermatic in place of hypodermic, as the term hypodermic is not sanctioned by scholars; but the use of the less exact word is now so firmly established that it will be difficult to substitute the more proper one for it.

Under the group of remedies affecting nutrition there are given valuable suggestions in regard to the subcutaneous use of mercury, of pilocarpine, and of iron; and various methods of transfusion are briefly considered. Then follows a group which is classed as agents having the power to destroy pathogenic microorganisms, among which are found a number of antiseptics and antipyretics.

A large portion of the work is devoted to morphine, the treatment of the opium habit, and the antagonisms between atropine and other alkaloids. Following this, and also among the remedies which affect the nervous system, are strychnine, the digitalis group, cocaine, caffeine, and ergot. The subcutaneous use of quinine is, of course, taken up, and the peculiar advantage of the subcutaneous method of administering it is insisted on. Of the remaining topics, those of amylhydrate, nitroglycerin, and apomorphine are among the more important.

Besides a consideration of the subcutaneous use of the remedies, their history, properties, physiological action, and uses are given. The work has many suggestions of practical value, but things of secondary importance are also included in a work which aims to be complete.

Dr. Bartholow recommends the hypodermatic use of atropine in asthma. Morphine is treated very fully, and the author takes the ground that it is not so much used as it deserves to be in relieving pain after operations and injuries, especially during the first few hours after fractures or dislocations.

So far as the reviewer is aware, this work is the largest and most comprehensive which has been written on this subject, and the well-known and distinguished author has evidently taken great pains to include all that has a bearing upon the subject of hypodermatic medication.

F. H. W.









THE TREATMENT OF PNEUMONIA. In the Edinburgh Medical Journal, 1891, No. clxxxvii. p. 393, DR. GEORGE W. Balfour presents an instructive paper advocating the use of chloral combined with digitalis; the avoidance of preliminary purgation; the moderate use of digitalis to prevent cardiac collapse and as an antipyretic, with chloral to combat the insomnia, pain, and cough. The precise method is Liebreich's chloral--none other being regarded by the writer as safe-dissolved in infusion of digitalis. For an adult twenty grains of chloral dissolved in half an ounce of infusion of digitalis, in four hours ten grains in the same amount of infusion, and so continued until the temperature falls to the normal, when it is replaced by an appropriate tonic. A jacket poultice is a useful adjuvant, which may be, however, replaced by a sheet of cottonwool. Suitable diet cannot be dispensed with. [In the Report of St. Thomas's Hospital, for 1889, the mortality from pneumonia was 20.5 per cent, while 53.6 per cent. of the cases ended with a crisis—40 per cent. ending thus on the fifth or seventh day. Evidently the type and severity of the disease is different in Great Britain.-Ed.]

TREATMENT OF PNEUMONIA BY DIGITALIS IN LARGE DOSES. Dr. SIGMUND LOWENTHAL gives a very careful review of the literature (Centralbl. f. Gesammte Therapie, 1891, Heft xi. S. 541). He uses a daily dosage of forty-five to sixty grains of selected leaves in the form of infusion until the crisis, which came on the third or fifth day after the commencement of his treatment in his twelve cases, all of which were dismissed cured. His conclusions are: Fever but slightly influenced; the pulse-rate frequently reduced, but with this reduction came often a rise in the rate of respiration (relative dyspnea); urinary analysis as is usual in pneumonia ; expectoration frequently difficult; marked adynamia; heart weak, circulatory disturbances; in this method of using digitalis we do not obtain a specific action. The author remarks that in certain cases where from circulatory disturbances digitalis is indicated, he has had brilliant results from a single dose, size above noted.


PROF. Julius SOMMERBRODT, in the Berliner klinische Wochenschrift, 1891, No. 43, S. 1048, presents an eloquent plea for the use of this remedy for the cure of tuberculosis. In 1887 he published the results of his observations during the preceding nine years, the maximum daily dose being under eight drops. He became convinced that with this dose complete cure could be obtained in the early stage of the disease. His present paper is intended to demonstrate that this dose can be largely exceeded with safety, and that more severe cases and those of longer duration cannot only be relieved, but, indeed, cured. He considers it, in a daily dosage of one quarter to one drachm, to be the most valuable remedy against tuberculosis. In support of his position he cites twelve cases. Quoting Nathan, Sée (with compressed air in pneumatic cabinet), Tappert [Tapret ?], Grasset, and Schüller (with surgical methods) as to the value of this remedy, he advises that it be prescribed in gelatin capsules containing one and a half drops in company with cod-liver oil. He objects to its administration with balsam of Tolu, or in the form of pill, on account of its variable absorption; nor does he prescribe guaiacol, since he does not believe that this represents the entire therapeutic value of creasote. When the cost of the pills must be considered, he recommends Hopmann's mixture (one part creasote, two parts tincture of gentian) diluted with water, or in Hungarian wine. He approves of all accessory means of cure-climatic, open air, pulmonary gymnastics, nourishing diet--but he insists that the treatment must be of long duration. He finds that it does not disagree with the stomach, although at the commencement of treatment it may be necessary for a time to interrupt its administration. [The duration of the observations, the large number of patients under treatment, give this report an especial value.-ED.]


In the Gazette Médicale de Paris, 1891, No. 36, p. 421, DR. A. FESTAL figures an apparatus for this purpose, and gives his method of procedure. Giving creasote the first place among the remedies for tuberculosis, he cites the difficulties arising from its administration by the mouth, and the limitations of dosage by inhalation or inunction. Although believing the method of inhalation of compressed air saturated with creasote vapor (Tapret) to be valuable, yet the expense and complexity of the apparatus will limit its usefulness. He uses pure creasote, one to fifteen in vegetable oil, washed with alcohol and sterilized by boiling, for hypodermatic injection by the method of Gimbert (de Cannes). The purpose of the apparatus (which resembles an aspirator to which is attached a funnel for introducing the medicament into the barrel, and a spring to furnish a constant motion to the piston) lies in the

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