THE REVIEWER'S TABLE

Books, Reprints, and Instruments for this department, should be sent to the Editors, St. Louis.

INTERNATIONAL

CLINICS. A Quarterly of Illustrated Clinical Lectures and especially prepared articles on Treatment, Medicine, Surgery, Neurology, Pediatrics, Obstetrics, Gynecology, Orthopedics, Pathology, Dermatology, Opthalmology, Otology, Rhinology, Laryngology. Hygiene and other topics of interest to students and practitioners. By leading members of the medical profession throughout the world. Edited by A. J. O. Kelly, A.M, M D., Philadelphia. Volume I and II. Fifteenth serles 1905. Philadelphia and London. J. B. Lippincott Co. (Cloth $2.00,)

The scientific value of a publication like the International Clinics is to be found in its practical presentation of new (or old for that matter) methods of practice and of the real practical advantage which progressive thought gives to the practitioner. We commend the International Clinics for this especial consideration of the needs of the physician in active practice. This quarterly number contains the following well written and well selected contributions: (1) treatment of cardiac asthma, by P. Merklea; (2) treatment of cirrhosis of the liver, unusual syphilis, tuberculosis, suffocative catarrh, and mucomembranous enterocolitis, by Albert Robin; (3) therapeutic indications in infected cholelithiasis, by A. Cauffard; (4) carbohydrates of human urine in health and in disease, by Carstair Douglass; (5) the eye and the hand in the diagnosis of heart disease, by James J. Walsh; (6) early diagnosis of heart disease in children, by J. Porter Parkinson; (7) aortic stenosis, adherent pericardium, by Morris Manges; (8) intestinal adhesions and hepotoptosis, by A. L. Benedict; (9) skin grafting in the late treatment of severe burns involving extensive areas of skin, by Archibald Young; (10) starvation of malignant growths by depriving them of blood supply, by Robert H. M. Dawbarn; (11) new operative method for the total extirpation of the larynx, by Francesco Durante; (12) treatment of knee-joint disease, by Russell A. Hibbs; (13) treatment of Glenard's disease, by A. Ernest Gallant; (14) morphinomania, cocomania, and general narcomania, and their legal consequences, by Charles K. Mills; (15) a case of cerebellar tumor, by J. Walter Carr; (16) two cases of ocular palsy depen dent on a lesion in the neighborhood of the sphenoidal fissure, by Edwin Bramwell; (17) anterior and posterior parietal presentations of the head in slightly flattened pelves. Concluding the volume is a resume of practice for the year 1904, which is of great interest and value.

In this volume are to be found carefully selected contributions on Treatment, Medicine, Surgery. Gynecology, Ophthalmology, Rhinology, Physiology and Pathology, by such well known writers as J. L. Morse, G.

Hayem, D. B. King, R. T. Eades, R. T. Willson, S. S. John, H. Rogers, J. R. Williamson, A. L. Bendict, E. M. Corner, G. F. Lydston, D. N. Eisendrath, T. H. Manly, C. G. Cumiston, C. D. Palmer, N. H. Pierce, J. C. Hemmeter and others.

PROGRESSIVE MEDICINE. Volume VII, June, 1905. A Quarterly Digest of Advances, Discoveries and Improvements in the Medical and Surgical Sciences. Edited by Hobart Armory Hare, M.D. Professor of Theradeutics and Materia Medica in the Jefferson Medical College of Philadilphia. Octavo, 346 pages, illustrated. Pliladelphia and New York: Lea Brothers & Co. (Per annum, in four clothbound volumes, $9.00; in paper binding, $6.00, carriage paid to any address)

Progressive Medicine continues to sustain its reliable selective and judicious resume of progress in the art and science of medicine and surgery. Each volume carefully edited by Hare with the able staff of contributors whose authority in their special fields of practice is unquestioned, presents the latest and best of modern methods of practice, scientific thought and trustworthy deductions in research work Volume VII, No. 2, presents Coley's review on Hernia, which is exhaustive and thorough, showing the advancement made in this important field of surgical practice. Edward M. Foote considers abdominal surgery (exclusive of hernia) in a masterly manner, in which he details the newer practices in surgery of the stomach which is today attracting so much deserved attention. The surgery of the intestines, peritoneal cavity, gall bladder and bile ducts and spleen are next reviewed, showing that progress in abdominal surgery is becoming simplified, and with the results that are a credit to American surgery, which leads the world in this field. Gynecology by Clark is in keeping with his former excellent contributions, and shows that while some observers are inclined to speak of the passing of gynecology into emergence with general surgery, really gynecology is defining itself more and more as a specialty as research work and conservative operative procedures goes on. Stengel, who of American writers stands among the formost in clinical study of diseases of the blood, metabolic diseases, diseases of the thyroid gland and lymphatic system has given a very complete review of this field of clinical medicine. The contribution on ophthalmology is by Edward Jackson, who has every since this publication was first issued has yearly given an excellent epitome of progress in ophthalmology. Jackson is a scientific observer, a careful and skillful clinician, hence the value of his work.

F. P. N.

F. A. DAVIS COMPANY, of Philadelphia, have the pleasure of announcing the early publication of a work long expected and urgently demanded by the medical profession. It is a Treatise on the Motor Apparatus of the Eyes, embracing an Exposition of the Anomalies of the Ocular Adjustments and their Treatment, with the Anatomy and Physiology of the Eye Muscles and their Accessories, by Dr. George T. Stevens, of New York. Dr. Stevens's work is a systematic development of the subject of adjustments of the eyes. He advances the anatomy and physiology of adjustments to perspective and the psychology of sight, and at length to the classes of anomalies as they arise from variations from normal types. From his unequaled experience he has evolved a rational and philosophic system of treatment. Thus is wrought into a continuous whole one of the most interesting as it is one of the most important of subjects in the science of medicine. It is to be profusely and elegantly illustrated in colors and in black and white, mostly from the author's own drawings. The illustrations in Comparative Anatomy are of especial interest. It will be complete in one royal octavo volume of about 500 pages.

THE NATIONAL STANDARD DISPENSATORY is a new work, a distinct improvement upon anything of the kind hitherto published. Its authors, Dr. H. A. Hare, of Philadelphia; Prof. Charles Caspari, Jr., of Baltimore; and Prof. H. H.Rusby, of New York, are all men of the highest eminence in their respective fields, and are all members of the Revision Committee of the U.S. P. They have carefully matured its plan so as to render the maximum service to both professions it interests, namely, Pharmacy and Medicine. It not only covers the new U.S.P. as aforesaid (and the chief foreign pharmacopoeias as well), but the scarcely less important domain of the unofficial drugs and preparations so largely used. It offers full information regarding the pharmacognosy, the pharmacy, and the medical action and uses of all substances used in Pharmacy and Medicine at the present day. Pharamceuti

cal methods and products are covered, with descriptions of the most approved apparatus and tests. Dr. Hare has again justified his reputation for knowing what is wanted by giving a compact and direct presentation of modern therapeutics in the section dealing with that subject in the case of each drug. The appendix contains useful tables, formulas, etc., for practical work. There are two indexes, the general, covering all the names

the text, and so affording a guide to the

ONE of the latest places announced to be infected with plague is Amoy, China, a treaty port trading principally with the island of Formosa, where bubonic plague has prevailed extensively. Amoy, an unsanitary city situated on an island opposite the center of Formosa, is also in commercial relations with Bombay, Bengal, Shanghai, and Formosa. The inhabitants are principally engaged in the coasting trade. The export trade of Amoy, once extensive, has diminished in late years.

THERE is some anxiety in St. Petersburg lest an epidemic of cholera add to the troubles of that unhappy country, says an exchange. A dispatch from Sosnovice, Poland, reports that deaths are occurring daily there, and that three suspected cases are reported at Tula. The authorities of both these cities have ordered anticholera inoculations in the infected regions. At Harbin about 100 deaths occur daily from cholera and dysentery, and it is feared that the disease may spread thence along the Siberian railway into European

Russia.

THE AMERICAN ASSOCIATION OF OBSTETRICS AND GYNECOLOGISTS will hold its eighteenth annual meeting at the Hotel Astor, New York, Tuesday, Wednesday, and Thursday, September 19, 20, and 21, 1905, under the presidency of Dr. Howard Williams Longyear of Detroit. Dr. Robert T. Morris, 616 Madison Avenue, chairman, Dr. Samuel W. Bandler, 229 West 97th street, and Dr. Jas N. West, 71 West 49th street, constitute the local committee of arrangments, one or all of whom will furnish information to members and guests upon application. Dr. William Warren Potter, of Buffalo, is secretary of the association.

REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Department Staff.

SURGERY.

JOHN MCHALE DEAN, M. D.

Some Remarks on Cases Involving Operative Loss of Continuity of the Common Bile Duct. -In Annals of Surgery Wm. J. Mayo discusses the loss of continuity of the common bile duct and his method of alleviating same. While fortunately this condition is not of common occurrence, its remedy is difficult. Cases of carcinoma of the common duct as well as previous operative destruction call for this operation. Where the gall bladder is intact cholecytenterostomy can be performed in the hope of having the bile enter the intestine in this way. Where the gall bladder

cannot be used for anostomoses the duct when incised can be, according to the author, sutured together with fine catgut through all the coats. Where this is impractical the author makes an anastomoses between the duct and the duodenum. In performing this operation the author urges against the use of gauze or other drainage close to the anastomatic sutures. In a case he claims the removal of the gauze drain tore the stitches out by becoming firmly adherent. A biliary fistula formed but resulted fatally. In reviewing the surgery on this point the author goes on to say: "The common duct may be united end to end, by through and through catgut sutures. It is essential that a few supporting sutures should be placed in the surrounding tissues, and that a portion of the circumference of the line of union be left open for relief of tension and drainage. Second, the common, and in certain cases the hepatic, duct may be implanted into the duodenum, provided a peritonal covered portion of the intestinal be chosen for the purpose. Third, to facilitate these operations, the second portion of the duodenum should be loosened and drawn to the right and held by fixation sutures, preventing tension on the duct suture line. Fourth, drainage, if necessary, should be pliable, covered with rubber tissue, and placed as distant to the suture line as will serve the purpose of protection against leakage."

Ligature of the Innominate Artery. In Annals of Surgery William Skeen, of England, reports the successful ligature of the innominate for aneurism of the subclavian. The author claims this operation was performed successfully seven times, three in the United Kingdom, three in the United States

same.

and once in India. The ligature was accomplished by a median incision. The apical pleura was injured, but packing remedied The aneurismal pulse ceased and the sac became almost undiscernible immedi. ately after the operation. The aneurism recurred and a second operation showed the ligature had become loosened. The condition recurred a second time, and finally a third operation resulted successfully. In concluding the author states: "1. That in properly selected cases ligature of the innominate is reasonably safe and undoubtedly useful operation. 2. That suitable cases are those in which the aneurism is of a circumscribed, globular character, and the general condition of the patient is otherwise good. That unsuitable cases are those in which the aneurism is what is commonly called fusiform, but is really often nothing more than part of a general arterial dilatation, and in which there are marked signs of general arteriosclerosis with accompanying visceral disease. 3. That the maintenance of sepsis is the main factor in obtaining a successful result. 4. That the incision should be central with horizontal and vertical incision of the manubrium, if necessary. 5. That the carotid should be tied as well as the innominate. 6. That silk is the best ligature material. 7. That some amount of injury to the inner coats is probably necessary to insure occlusion, but that with aspetic conditions such injury does not matter. injury does not matter. 8. That two ligatures should if possible be placed round the vessel, the first turn of the proximal ligature being held tight, so as to keep back the blood while the distal ligature is completely tied. 9. That the use of a drainage-tube is inadvisable. 10. That as a study of the recorded cases shows that, next to sepsis, some cerebral lesion has been the most frequent cause of death after operation, it would be well for future operators to consider the advisability of tying the carotid about a fortnight before the innominate. 11. That "Valsalvan" methods of treatment immediately prior to operation are inadvisable.

The Surgeon and the Pathologist. Dr. J. Collins B. Warren in a able address before the American Medical Association (in J. A. M. A.) develops forcibly the relation that should exist between the surgeon and the pathologist. In flattering terms he lauds the American physician, and claims originality can be found at the present date as much here in this country as in the European continent. Truly skill in surgery cannot be surpassed anywhere, and in the near future Europeans, following the long established custom of Americans in, going abroad, will be

forced to seek new ideas in pathology, medicine and surgery in the United States. The author with much benefit to the subject classifies the benign and malignant conditions of the female breast. Heretofore the classification was confusing, and as such misleading. His classification is as follows: Carcinoma. Fibro-epithelial Tumors.1. Fibrous type: a. Periductal fibroma. b. Periductal myxoma. c. Periductal sarcoma. 2. Epithelial tpye (cyst-adenoma): a. Fibro cyst adenoma. b. Papillary cyst adenoma.

Hyperplasia.-1. Diffuse hypertrophy. 2. Abnormal involution, cystic, proliferative.

Chronic Inflammation.- 1. Eczema of nipple 2. Chronic abscess. 3. Ductal mastitis. 4. Tuberculosis. 5. Single retention cyst.

Non-Indigenous Tumors.-1. Sarcoma. 2. Lipoma. 3. Lymphangioma.

Supernumerary Breast.

A Case of Varicose Veins Simulating Femoral Hernia. Dr. William J. Taylor in a paper read before the Philadeplhia Academy of Surgery reports a case of varicose veins simulating femoral hernia. Operation disclosed a large varicose condition of the saphenous vein. It was ligated after being emptied. Patient improved till the third day when patient went in collapse. Stimulants were used unsuccessfully and death ensued. Post mortem showed a marked thrombosis of the right auricle of the heart.

A Popliteal Aneurism.-Dr. John H. Gibbons before the Philadelphia Academy of Surgery reports a successful result in operation for a popliteal aneurism according to the Mata's modification.

PATHOLOGY AND BACTERIOLOGY.

R. B. H. GRADWOHL, M. D.

The Bacteriology of Appendicitis.-Peronne (Annales de l'Institut Pasteur, Tome XIX, No. 6, 1905) examined 14 cases of appendicitis bacteriologically. These cases were operated upon by Gosset at the surgical clinic of the Hospital Pitié, Paris, service of Prof. Terrier. The first observations upon the bacteriology of appendicitis were made by Hodenpyl and Lanz and Tavel in 1893. In all cases examined by Hodenpyl, he found the bacillus coli communis in 10 instances in pure culture, and in the other case the bacillus coli plus the streptococcus pyogenes. In 24 cases collected in the literature by Hodenpyl, the bacillus coli was found in pure culture 2 times, the bacillus coli plus the bacil

lus pyogenes fetidus once, and the streptococcus pyogenes but once. In 1897 Mayer examined 40 cases; in 25 cases the pus was sterile; in 29 cases it showed the coli bacillus; in 2 cases, the staphylococcus aureus ex. clusively, and in 19 cases, the bacillus described by Tarel as the pseudotetanic bacillus. In the same year, Achard and Broca reported their observation upon 20 cases of suppurative appendicitis, to wit, in 5 cases the colon bacillus alone, in 10 cases the colon bacillus associated with other bacilli; in 6 cases the colon was associated with the streptococcus, and in each instance with the pneumococcus. Kelly found the colon bacillus in 73% of his cases. The most important communicationon this subject is that of Lanz and Tavel published in Revue de Chirurgie, No. 7, 1904; they examined 8 normal appendices and 138 pathological appendices. In the normal cases, they found the strepto. coccus in 2 cases, the diplostreptococcus intestinalis in 3 instances, the coli bacillus in 8 cases, the proteus once, the bacillus of malignant edema 5 times and the pseudo-tetanus bacillus 5 times. None of these appendices were sterile. In the pathological ap pendices they found in 94 cases, the diplo streptococcus in 62, the pneumococcus in 3, the tetragenous in 1, the staphylococcus 1 case, the bacillus colon in 105, the pneumococcus in 6, the proteus in 5, the bacillus of ma lignant edema in 49, the pseudo-tetanus in 59, the pseudo-diphtheria in 2 cases. They found a sterile condition in 14 instances, but one bacterial species in 1 instances; two species in 24 instances, three in 23, four in 35, 5 in 15 and 6 species in one instance. They believe that the healthy appendix is never sterile. They believe that the pathological appendix is sterile in 10% of the cases. The bacterial flora of the appendix is similar to that of the large intestine. The pathological appendix shows many leucocytes, which may account for the disappearance of bacteria. In 14 cases studied by Peronne, he found the bacillus coli in 10 instances, the diplostreptococcus in 6, the streptococcus in 4, the pneumoncoccus in 1, the staphylococcus in 1, the bacillus pyocyaneus in 1, the bacillus fragilis in 7, the bacillus perfringens in 6, the proteus in 2 and the bacillus fusiformis in 1 instance. The appendix was found sterile in 1 instance; one species was found in 1 instance, 2 species in 3 instances, 3 in 5 instances, 4 in 3, and 5 in 1 instance. The diplostreptococcus found is one called by Tavel the diplostreptococus intestinalis. The streptococcus is one called variously streptococcus pyogenes, the erysipelatos of Fehleisen, of puerperal fever of Pasteur-Doleris, etc. The bacillus fragilis of Veillon and

Experimental Study of the Effects of the Dysenteric Toxin upon the Nervous System.Ch. Dopter (Annales de l'Institut Pasteur, Tome XIX, No. 6, 1905) gives an account of his experimental work with the toxin of the dysenteric bacillus. While working upon

re

rabbits inoculated with broth cultures of the bacillus dysenteriae (Shiga), Dopter and Vaillard in 1903, noted that these animals show a paralysis after three or four days, in 75% of the cases. Clinically, the rabbits display a paraplegia, coming on either suddenly or progressively, accompanied by a vesical paralysis. It may remain localized or may travel forward affecting the anterior extremities, presenting the appearance of Bandry's syndrome. Sometimes, the forelegs of the rabbit were affected first, the hind-legs becoming later affected. Some time, the paralysis, although bilateral remained unilateral, taking on the appearance of a spinal hemiplegia. There was There was a complete absence of sensory symptoms. Sixteen rabbits were studied to determine the effects of the toxin upon the minute anatomy of the nervous system; the peripheral nerves, spinal cord, medulla, pons, etc., were moved, fixed in alcohol and Mueller's fluid, osmic acid, stained by various methods, Nissl, Marchi, Weigert-Pal, etc. Microscopically, the effects of the injection of toxin resemble the effects produced upon the nervous system by the injection of the bacillus dysenteriae itself. In a rabbit injected with 4 c.c. of culture of the B. dysenteriae (Kruse), displaying during life paraplegia of hind-legs, the dorsal cord showed decided changes in the anterior horns. There are present "l'etat chromophilique," swelling of the cells. In some places the cells are hydropic, showing peripheral chromatolysis. Rarely, the nuclei are extruded excentrically. The blood vessels showed dilatation. The lumbar portion of the cord showed the most decided lesions, sharply defined, irregularly shaped areas in the gray matter, with complete loss of cellular structures, only granular debris remaining and showing a faint

trace of cellular charactistics. The WeigertPal method shows complete interruption in the myelin fibers of the gray matter. The white matter shows no changes. The spinal ganglia show a slight chromatolysis of their cellular elements. In short the lesions consist of disseminated areas of necrosis developed in the two anterior horns of the lumbar cord, and diffuse alterations in the dorsal cord. In order to determine the effects of the toxin upon the peripheral nerves, a method was resorted to which has previously been used by Vincent with the typhic toxin and by Lafforgue with the choleraic and diphtheritic toxin, i. e., the direct injection of four or five drops of dysenteric toxin into the sciatic nerve of a guinea-pig; these in jections were repeated every five or six days. The opposite sciatic nerve was injected with a sterile bouillon solution at the same time. On the side injected with toxin, sensory disturbances occurred about the tenth day, i.e., hyperesthesia, hypoestheisa, slight paresis. After the fifteenth day, the animal was killed, the sciatic nerves and branches removed and put into 1% osmic acid, stained with picrocarmine and thionin; there was seen microscopically "segmentary periaxial necrosis, the nerve fibers being atrophic, without nuclei or protoplasm. There was segmentation of the myelin sheaths. It is conclusive that the dysenteric toxin when placed in direct contact with peripheral nerves produces alterations in their elementary fibres, or what may be called "Wallerian degeneration."

OTOLOGY.

ALBERT F. KOETTER, M. D.

The Morphine-Scopolamin Narcosis.-(Dr. A. Hieber, Breslau, Internationales Centralblatt fuer Ohrenheilkunde.)-The endeavors to find in place of the old new narcotics that were safer and more pleasant to use, must, after the results of the last few years, be credited to Schneiderlin who in 1900 discov. ered the morphine-scopolamin narcosis. As a sedative and hypnotic scopolamin has been used for some time, especially in conditions of excitement, and has responded promptly where other sedatives have failed. Deleterious affects were never noticed, even cases of poisoning recovering. In investigations on animals large doses, corresponding to the weight of the animal, could be administered without fatal results. Recently a combination of morphine and scopolamin was used, scopolamin hydrobromicum was used exclusively. The sleep produced was deep and quiet, without any bad after-effects, even