16. The conservative treatment may be employed in the presence of aseptic fistulæ, as the latter frequently heal spontaneously.

17. In some forms of tuberculous joints Bier's method of passive hyperemia is good treatment.

18. The contractures which remain after healing of the tubercular lesion may be remedied by orthopedic mechanical treatment, or by operation, such as osteomy, resection, etc.

19. If the tubercular lesion fails to heal under careful conservative treatment; if new abscesses continue to develop, and perhaps threaten life; it ichorous fistulæ exist or large sequestræ form; finally, if the tuberculosis runs a very rapid and grave course, it is advisable to resort to more radical operative procedures.

20. The operative treatment should be as conservative as possible; instead of typical, atypical resections or arthrectomies should be employed. The epiphyseal line, particularly in children, should be preserved.

21. With rigid asepsis the prognosis of resection has improved greatly.

22. After resection of a tuberculous joint, ankylosis in good position should be sought.

23. After resection or arthrectomy, contracture of the joints should be prevented by means of plaster of Paris bandages and portable apparatus.

24. Amputation should be considered only in cases in which there. is pronounced destruction of the entire joint and simultaneous presence of tuberculosis or amyloid degeneration of internal organs.-Therapeutic Gazette, January 15, 1905.

Local Analgesia.-Barker describes his method of producing local anesthesia. He uses B-eucain, which is far less dangerous than cocain, while possessing analgesic properties little, if at all, inferior to it, and with the concurrent use of adrenalin for the purpose of securing a retardation of circulation equivalent to constriction of the part, he has removed some of the objections as to the duration of the analgesia, the extent of the area which can be dealt with, and the amount of the toxic drug to be employed. It is necessary to keep within the safe dose of the drug, and to have at our disposal a large enough quantity of the fluid medium to render it possible to spread the analgesic agent over the large areas. For ordinary surgical work Barker finds the following solution to answer well: Distilled water, 140 c.c.; B-aucain, 0.2 grams; sodium chlorid, o.8 grams; 1 to 1,000 adrenalin chlorid

solution, 10 minims. All this quantity of fluid can be used in an ordinary case if necessary, and is quite sufficient for most. Twice as much may be injected without ill results. The duration of the insensibility is secured by the admixture of the adrenalin. Without it sensation is only abolished by eucain for about fifteen minutes; with it, for three to four hours. But the analgesia is prodnced more slowly when adrenalin is employed with the eucain. It is, therefore, well before all large operations to wait some thirty minutes after injection to allow time for the insensibility to become fully developed. After this the affect appears to deepen for a couple of hours. Waiting has another advantage. When eucain alone is employed the operation must be done at once. The tissues are still in a state of artificial edema which masks the anatomic details unpleasantly. By adding adrenalin to the eucain solution and waiting, the artificial edema has disappeared, and details are very clearly seen. Rapid injection is to be avoided; sudden distension of the tissues is disagreeable, if not painful. The fluid should not be used cold nor too hot, for the same All dragging on the parts is to be avoided lest structures be pulled upon which lie beyond the area of infiltration. Barker has never seen any depressing effects follow the use of B-eucain in a long series of operations. A list of operations done under B-eucain analgesia is appended, and among these are the following: Abdominal sections, hernia operations, amputations, orchidectomy, removal of cyst of thyroid, removal of silver wire from around the patella, operations for fistula in ano, varicose veins, hydrocele, variocele, etc.—Journal of the American Medical Association, January 21, 1905.

reason.

Definition and Classification of Gastric Hemorrhage.-F. G. Connell says that, although gastric hemorrhage may occur without hematemesis, still this is the only reliable, substantial, and practical sign of its occurrence, and, therefore, a study of gastric hemorrhage must necessarily be one of hematemesis. He divides hematemesis into two main types, chronic and acute. Acute hematemesis may be either symptomatic or non-symptomatic, aud each of these may be divided into multiple and single. The whole question, especially if the possible previous and after history be considered, is a complex one that apparently is in need of further study.—Medical Record, January 7, 1905.

BOOK REVIEWS.

SURGICAL TREATMENT OF BRIGHT'S DISEASE.-By Geo. M. Edebohls, A. M., M.D., LL.D, Professor of Diseases of Women in the New York Post Graduate Medical School and Hospital; Surgeon to St. Francis, St. John's, Riverside and Nyack Hospitals, etc. 327 pages. New York: Published by Frank F. Lisiecki.

There is no field of surgery that has been invaded in the last half century that has brought more comment and been more welcomed than than that of the kidney in Bright's Disease.

When such an authority as Professor Edebohls proposed to treat Bright's Disease by decapulation of the kidney in the year 1901, it came as a great surprise to both the medical and surgical world, for we had been taught to stay clear of operative work on this class of cases unless emergency drove us to, but that his ideas were correct in regard to cases being benefited by operation on the kidneys is an established fact, and the operation of decapulation has come to stay.

In the volume before us he gives us facts and information as regard results that are available up to the present time, and gives the history of seventy-two cases of chronic Bright's Disease operated on by him up to 1903.

While the work is new, the results would justify one in saying that surgery is the only treatment that offers hope to a hitherto incurable malady.

We congratulate Professor Edehohls on the production of the work, the way he has presented the subjects and the way they are dealt with, and bespeak for the work a large sale, as it should be on the shelf of every surgeon's library.

"MEDICAL AND SURGICAL REPORRS OF THE PRESBYTERIAN HOSPITAL " in the Edited by Drs. Andrew J. 327 pages. New York Published

city of New York. Volume VI, 1904.
McCosh and W. Gilman Thompson.
by Troy Diretory and Bookbinding Company.

:

The present volume is of especial interest to the profession. There are subjects discussed that are of great importance to both the general practitioner and the surgeon.

The article on treatment of advanced cases of general septic peritonitis from appendicitis by Forbes Hawkes is worth the time of any surgeon to read, while those on acute lobar pneumonia are of equal interest to the practitioner. The Presbyterian Hospital is one of the

foremost institutions of its kind in the country, and having connected with it the staff of such ability makes its report received with pleasure by us, and we feel much benefited by having read it.

THE SUPPRESSION OF TUBERCULOSIS. (Cassel Lecture.) Together with Observations Concerning Phthisiogenesis in Man and Animals, and Suggestions Concerning the Hygiene of Cow Stables and the production of Milk for Infant Feeding, with Special Reference to Tuberculosis. By Professor N. von Behring, University of Marburg. Authorized Translalation by Charles Bolduan, M.D. 12mo. 685 pages. Cloth, $1.00. New York: John Wiley & Sons, Publishers.

What has been said by some one regarding Daniel Webster may also be said of Professor E. von Behring, that "if you accept his premises you are bound to admit his conclusions." Fortunately, however, his statement that "the milk fed to infants is the chief cause of consumption " is qualified by the admission that there may be other factors operating in causing infection. Probably the most significant lesson to be drawn from this exceedingly interesting lecture is that the mucous membrane of new born individuals possesses no continuous epithelial covering, and that the gland tubes of the ferment producing glands are little if at all developed, thus allowing the true albumins to be absorbed as such, and at the same time admitting of the ready access of infectious material into the blood.

The remainder of the book is given up to certain observations relative to phthisiogenesis and a most excellent resume touching the hygiene of cow stables and the production of milk for infant feeding.

The translation is above criticism and the English reader should feel indebted to Dr. Bolduan for putting within his reach such excellent translations of the works of the great German scientists. We hope that other books of educational value will be brought out from time to time by the publishers. D. S. W.

BOOKS RECEIVED.

EYE, EAR, NOSE AND THROAT NURSING. By A. Edward Davis, A. M., M.D., Professor of Diseases of the Eye in the New York Post Graduate Medical School and Hospital, and Beaman Douglass, M.D., Professor of Diseases of the Nose and Throat in the New York Post Groduate Medical School and Hospital. With 32 Illustrations. Pages XVI-318. Size, 5% x 77% inches. Extra Cloth. Price, $1.25 net. Price, $1.25 net. Philadelphia: F. A. Davis Company, Publishers, 1914-16 Cherry Street.

MANUAL OF OPERATIVE SURGERY. By John Fairbairn Binnie, A.M., C. M.,

(Aberdeen), Professor of Surgery Kansas City Medical College, Kansas City, Mo., Fellow of the American Surgery Association, Member de la Societe Internationale de Chiurgie. With 559 Illustrations, a number of which are Printed in Colors. Philadelphia: P. Blakiston's Sons & Co., 1905.

MEDICAL AND SURGICAL REPORT OF ST. LUKE'S HOSPITAL, Year Ending September 30, 1904. Chicago 1416-1436 Indiana Avenue and 1427 Michigan Avenue.

PRACTICAL PEDIATRICS

A Manual of the Medical and Surgical Diseases of Infancy and Childhood. By Dr. E. Graetzer, Editor of the Centralblatt Fur Kinderheilkunde and the Excerpta Medica. Authorized Translation, with numerous Additions and Notes. By Herman B. Sheffield, M.D., Instructor in Diseases of Children, and Attending Pediatrist (O. P. D.) New York Post Graduate Medical School and Hospital; Visiting Pediatrist to the Metropolitan Hospital and Dispensary, etc. Pages XII-544. Crown Octavo. Flexible Cloth, Round Corners. Price, $3.00 net. Philadelphia: F. A. Davis Company, Publishers, 1914-16 Cherry Street.

NOTICES.

The following report has been received by us from E. E. Ladd, Chemist and Food Commissioner, Fargo, North Dakota, U. S. A., November, 1904, and is an abstract from North Dakota Agricultural College, Government Agricultural Experiment Station of North Dakota, Bulletin No. 63:

"This product is largely advertised and sold in North Dakota, and has frequently found its way to our laboratory for analysis. It is made by the Liquid Ozone Company, Chicago. After enumerating fifty diseases for which liquozone is recommen led, they add: All diseases that begin with fever -all inflammation, all catarrh in any part of the body, all contagious diseases, all the results of impure or poisoned blood.' We will pay $1,000 to the physician or scientist who discovers a disease germ which liquozone will not kill. Liquozone, liquid oxygen invariably cures any trouble caused in any way by germs.' It will be seen by the last statement an attempt is made to convey the idea that liquozone is liquid oxygen, a ridiculous and false statement. They would have the public believe liquozone a 'cure all' for everything from weak eyes to asthma, pneumonia and piles. In water it will purify it, and prevent tvphoid. In milk it will sterilize it, and in beer it prevents fermentation and biliousness.

"What is this wonderful product so persistently advertised and lauded by its interested pro noters? One sample of liquozone was found to contain a total acidity of 1.34 per cent., of which 1.18 per cent. was in the form of sulphuric and sulphurous acid. The total solids of black liquid residue of acid reaction amounted to 1.82 per cent., and the ash residue to 0.025 per cent. The character of the solid and ash clearly indicate free acid. Other samples examined by us have shown an acid content as high as 1.73 per cent., ind cating that the product is not by any means uniform in its composition. The free use of any product containing this amount of uncombined sulphuric and sulphurous acid can not be looked upon as wholly without possible harmful effect upon the human system. The public will do well to use such products only upon the advice of the family physician."