eral practitioner, for whom this series is especially valuable.

An admirable selection of papers has been made and the abstracts, while brief and to the point, set forth the practical points with such a degree of clearness that they can be readily understood and the information intelligently applied.

The trend of modern surgery is well depicted in this small volume, and after perusal of its pages one can hardly recall a single meritorious contribution which has not been reviewed in a fair and impartial manner. The editor has added many comments, which, coming from such an authoritative source, must necessarily add to the value of the book. A. I. B.

III. December. "The Eye, Ear, Nose and Throat." Edited by Casey A. Wood, C. M., M. D., Albert H. Andrews, M. D., T. Melville Hardie, A. M., M. D. These year books are written primarily for the general practitioner, and for his reference are certainly very convenient and complete. The names of the editors carry a sufficient guarantee, to those who know the men, that the work of selecting and arranging the material has been well and conscientiously performed, and the reviewer finds little calling for unfavorable criticism.

C. D. W.

SAUNDERS' HAND ATLASES. "Atlas and Epitome of Diseases of the Mouth, Pharynx and Nose." By Dr. L. Grünwald, of Munich. Translated from the German. Second edition, revised and enlarged. Edited by James E. Newcomb, M. D., Instructor in Laryngology, Cornell University Medical College, Attending Laryngologist to the Roosevelt Hospital and to the Demilt Dispensary, New York City. With 143 illustrations, 102 of which, on 42 lithographic plates, are colored. Pages 219, in addition to plates with detailed description of each illustration. Price in cloth, $3.00 net. Philadelphia and London: W. B. Saunders & Co. Chicago: W. T. Keener & Co. 1903.

A handy octavo volume, one-half of which consists of lithographic colored plates, showing the numerous diseased conditions of the mouth, naso-pharynx and nose, with elaborate discriptive text relating to same, while the other half contains 219 pages of text, illustrated by 41 wood cuts, and constitutes a clearly written and concise description of the various pathologic conditions of the parts implied by the title of the book, though the greater amount of attention is devoted to the pathology and treatment of the more serious of these diseases, as might be expected from such an author as Dr. Grünwald.

The author is to be praised as to the excellence of his work, and to the translator thanks are to be extended for having provided so valuable an addition to our works on rhino-laryngology for the special benefit of those who have not the advantage of a reading knowledge of German. This work in size and finish mates nicely with its companion works, viz: the Atlas of Otology and the Atlas of Diseases of the Larynx.

EDWIN PYNCHON.

"Atlas and Epitome of Human Histology and Microscopic Anatomy." By Privatdocent Dr. J. Sobotta, of Wurzburg. Edited, with additions, by G. Carl Huber, M. D., Junior Professor of Anatomy and Histology, and Director of the Histological Laboratory, University of Michigan, Ann Arbor. With 214 colored figures on 80 plates, 68 text illustrations

and 248 pages of text. Philadelphia and London: W. B. Saunders & Co. Chicago: W. T. Keener & Co. 1903. Cloth, $4.50 net.

This work will serve both as an atlas and as a textbook, the descriptions being concise but not too brief. Unlike some works purporting to treat of human histology and which portray specimens from animals, the great majority of the sections have been made from fresh human tissues. The American editor, who is well known for his researches in the field of minute anatomy, has made important additions, notably in the sections on adenoid and muscular tissues, the organs of the senses

and the peripheral nerves. The work will be found useful by both student and practitioner, either as an atlas, text-book, or for reference.

"A Manual of Practical Hygiene for Students, Physicians and Health Officers." By Charles Harrington, M. D., Assistant Professor of Hygiene in the Medical School of Harvard University. New (2d) edition, revised and enlarged. In one octavo volume, of 755 pages, illustrated with 113 engravings and 12 full-page plates in colors and monochrome. Philadelphia and New York: Lea Brothers & Co. 1903. Cloth, $4.25 net.

The demand for a second edition of this work within a little more than a year from the appearance of the first is very satisfactory evidence of the appreciation which it has met. The results of the progress have been incorporated in this second edition, and while making over seventy additional pages, by deducting the pages on quarantine laws, etc., the volume has been kept within reasonable size. Among the noteworthy additions is a chapter on the Relation of Insects to Human Diseases, with appropriate illustrations. We should like to have seen some mention of railway hygiene, which is bound to be a subject of great importance in the near future.

"The Surgical Diseases of the Genito-Urinary Organs." By E. L. Keyes, A. M., M. D., LL. D., and E. L. Keyes, Jr., A. B., M. D., Ph. D. A revision of Van Buren and Keyes' textbook. With 174 illustrations and 10 plates, 8 of which are colored. New York and London: D. Appleton & Co. Price, cloth, $5.00.

The latest edition of this old favorite has been so revised as to be practically a new treatise.

The work is divided into two parts. Part I is devoted to diseases of the urinary organs and gonorrhea, and comprises 648 pages. After a consideration of the anatomy and physiology of the urethra, strictures, diseases of the prostate, bladder, ureter and kidney are discussed successively. The authors advise sterilizing catheters by boiling for fifteen minutes. Part II treats of diseases of the genital organs, and occupies 160 pages.

From a mechanical standpoint, the work is a fitting addition to the series of artistic productions from this house, among them being Oster's Practice, Bryant's Surgery, Williams' Obstetrics, and Tuttle on the Rectum.

It only remains to add that the work will be welcomed alike by students, practitioners and specialists.

AMERICAN EDITION OF NOTHNAGEL'S PRACTICE.

"Diseases of the Stomach." By Dr. F. Riegel of Geissen. Edited, with additions, by Charles G. Stockton, M. D., Professor of Medicine in the University of Buffalo. Handsome

octavo volume of 835 pages, illustrated. Philadelphia, New York, London: W. B. Saunders & Co. Chicago: W. T. Keener & Co. 1903. Cloth, $5.00 net; half morocco, $6.00

net.

This volume, like the others of this excellent practice, is thorough and complete. Part I takes up general diagnosis and treatment of diseases of the stomach, and occupies nearly 300 pages. In Part II the special diagnosis and treatment are considered, together with disorders of the stomach function in other diseases, the latest being a novel but eminently practical subject.

The author informs us that twenty years ago "the pathologic anatomy of gastric lesions was the principal subject of investigation; attention is directed nowadays chiefly to perversions of the physiologic function of the stomach." As regards chemical examination of the contents, he emphasizes the fact that it is valuable only in combination with other findings.

There are 29 cuts and 6 plates.

The eminent editor, a recognized authority on diseases of the stomach, has added to the already excellent German text his own extensive experience, bringing the work in accord with our present knowledge. We are confident that for scientific excellence and completeness, as well as for mechanical perfection, this work stands unrivaled.

"Diseases of the Pancreas, Diseases of the Suprarenal Capsules, and Diseases of the Liver." By Dr. L. Oser of Vienna, Dr. E. Neusser of Vienna, and Drs. H. Quincke and G. HoppeSeyler of Kiel. The entire volume edited, with additions, by Frederick A. Packard, M. D., late Physician to the Pennsylvania and to the Children's Hospitals, Philadelphia; and Reginald H. Fitz, M. D., Hersey Professor of the Theory and Practice of Physic, Harvard University Medical School, Boston. Handsome octavo of 918 pages, illustrated. Philadelphia, New York, London: W. B. Saunders & Co. Chicago: W. T. Keener & Co. 1903. Cloth, $5.00 net; half morocco, $6.00 net.

The first section on Diseases of the Pancreas occupies 303 pages, and 104 are taken up by anatomy, physiology and general pathology. Most of the space is devoted to pancreatic cysts, 27 cases of these, so we learn, being of traumatic origin. Injuries of this gland are rather rare, as might be expected from its protected position. The section closes with an enormous bibliography of no less than 33 pages.

Heusser's section on the adrenals combines but rather scanty knowledge of the affections of these as yet mysterious organs. Seventy-four pages, however, are occupied with the anatomy, and a very full account of Addison's disease.

The bulk of the volume is taken up by a consideration of the diseases of the liver and of the bile passages (524 pages). First there is an introductory section of 89 pages on the anatomy of the liver, general pathology and physiology, and treatment. The diseases of the bile passages come next, the part on gall stones embracing over 80 pages, with a good bibliography. After this the various affections of the liver are discussed in order. It is interesting to note that Dr. Packard considers Talma's operation affords encouraging results in the ascites of cirrhosis.

numerous editorial additions the articles are brought fully up to date, and have no equal in our language.

"The Care of the Baby." A Manual for Mothers and Nurses, containing Practical Directions for the Management of Infancy and Childhood in Health and Disease. By J. P. Crozer Griffith, M. D., Clinical Professor of Diseases of Children in the Hospital of the University of Pennsylvania; Physician to the Children's Hospital, Philadelphia. Third edition, thoroughly revised. 12mo., 436 pages, fully illustrated. Philadelphia, New York, London: W. B. Saunders & Co. Chicago: W. T. Keener & Co. 1903. Cloth, $1.50 net. Of the many books on this subject this is one of the best. The fact of a third edition being called for within. such a short time is sufficient evidence of its popularity. In preparing this edition every part has been carefully revised and brought fully in accord with the latest advances in the subject. Several new recipes have been included, making the appendix even more complete than before. A large number of new illustrations have been added, greatly increasing the value of the book to mothers and nurses. The work is distinguished by soundness of advice, conciseness of expression, and clearness of style. Physicians could not perform a better service for their patients than the recommending of this excellent work to every mother.

"Practical Points in Nursing." For Nurses in Private Practice. With an Appendix containing Rules for Feeding the Sick; Recipes for Invalid Food and Beverages; Weights and Measures; Dose List; and a full Glossary of Medical Terms and Nursing Treatment. By Emily A. M. Stoney, late Superintendent of the Training School for Nurses, Carney Hospital. Third edition, thoroughly revised. 12mo., 458 pages, fully illustrated, including 8 colored and half-tone plates. Phiadelphia, New York, London: W. B. Saunders & Co. Chicago: W. T. Keener & Co. 1903. Cloth, $1.75 net. The continued and increasing popularity of this little volume has placed the publishers under the obligation of keeping it abreast of the times, of making it reflect the latest advances in the progressive profession of nursing. The revision has been extensive, every page showing evidences of careful scrutiny. Considerable portions of the work have been either amended, modified, or amplified in accordance with the progressive spirit of medicine and its indispensable handmaid, nursing. The sections treating of certain diseases, especially the infectious diseases, as well as the treatment of the common poisonings, have been in large part recast and rewritten. By the extensive revision the usefulness of the book has been greatly extended and its trustworthiness enhanced. There is no doubt that the work in its third revised form will maintain the popularity justly won by the earlier edition.

PAMPHLETS RECEIVED.

"Some Problems of Preventive Medicine," by Burnside Foster, M. D., of St. Paul, Minn.

"Renal Decapsulation for Chronic Bright's Disease," by George M. Edebohls, A. M., M. D., of New York. "Clinical Observations on the Surgery of the Gall Bladder-The Surgical Treatment of Tuberculous Peritonitis. Essentials in the Construction of Hospitals for Large Cities," by A. J. Ochsner, B. S., M. D., F. R. M. S., of

Railway Miscellany.

THE FIRST AID TO THE INJURED FALLACY.

To the Editors:

One of the most striking tendencies of modern times is the minute specialization of the different branches of one business, and in no profession have the changes been more rapid than in the management of railroads. This tendency to specialization has been so radical in the railroad business that it has brought about changes that might be termed revolutionary, and abuses have crept in as one of the sequences of such rapid growth.

On a great many systems of railroads each department is under the direction of an expert in his particular line, but who has received little or no training in any other line. Consequently he is more than apt to view all questions from the standpoint of his department, to the complete exclusion of all others. These departmental experts being usually men of technical education rather than commercial, they are prone to lose sight of the sole reason for which railroads are conducted as private enterprises, viz., for the greatest profit that their owners can secure from them.

When it is brought down to its last analysis, a railroad company is simply a commercial concern engaged in the selling of transportation. As such it is not bound to do anything more for the community, its patrons or employes than any other large taxpayer and good citizen engaged in other commercial pursuits. When this view of railroads is taken, it can readily be seen how far some departments have diverted it from its original purpose. In no department is this more noted than in the medical and legal. On some lines it can safely be said—and with this all minor officials will agreethat by the time the petty officer and operating employe complies with all the requirements of the medical and legal departments, he has very little time left to devote to the duties he is primarily employed to perform, and which are supposed to have direct bearing upon the company's revenue.

The medical department now seems to be the greatest offender on this line. Not satisfied with having an employe undergo a physical examination as severe as that required for the United States army, and undergo a color test, in which, if he pass a perfect examination, he will be found competent to match silks for a wholesale dry goods emporium, it must needs endeavor to make an embryo surgeon of him under the guise of giving him instructions in "first aid to the injured," befuddling his mind with prolix medical terms and taking up time that should be spent by the employe at home getting ac quainted with his wife and babies. Of course the sponsors for this system can show that their instructions are very elementary; a child could understand them. After reading their books of instructions and hearing their lectures, all must admit the system is made perfectly clear as to the theory, but as to practice, all the older officials will appreciate the difficulties and the impracticability of the scheme when they recall how hard it was to get their men to understand and carry out with uniformity and correctness the standard train rules when they were first adopted. Now, train rules are written in the simplest, most direct language possible, and all employes were thoroughly familiar with their intent before they were published; yet it was with extreme difficulty that some of the men could be made to have a thorough, comprehensive working knowledge of them, and these men were not always the dullest on the road. If it is difficult to get men to carry out the plainest instructions relative to matters they understand perfectly, how can they be expected to carry out the most elementary instructions relative to what is to them an obtuse science?

Let us examine their instructions on the most important point. They inform us that it is very easy to determine whether a vein or artery has ruptured by the color of the blood: that the arterial blood is of a deeper color than the venous. Another method is by determining the flow of blood,

the flow from an artery being in spurts and the flow from veins being steady. Every layman knows that it is out of the question for a railroad man to arrive at any conclusions as to which side of the wound to place the ligature by judging the blood from its color, and the usual railway injury is of such nature that he cannot determine by the other method. A great many other instructions are equally comprehensive and are of the same value to the employe.

Another great objection to this system is that it places within the reach of the employe anodynes, and although explicit and positive instructions are given as to their administration, yet the average railroad man is so tender-hearted that he will continue giving them as long as the patient shows any signs of great pain, regardless of all instructions to the contrary, and when the surgeon arrives upon the scene he has to treat the patient for opium poisoning before he can go ahead with the surgical procedure. (The writer has observed several cases of this kind.)

The supporters of this system are usually very enthusiastic, and are always able to sight numerous instances where it has proved of value; they can also display a kit of "first aid to the injured" supplies, which is certainly a commentary upon the thoughtfulness of human ingenuity. For the benefit of these people the writer will give some figures covering six years' work on a system of railroads comprising 2,500 miles, running through a very sparsely settled section of the country. He desires to say here that it was his duty to scrutinize each of the cases enumerated to see that there was not the slightest fault with the operating department in the handling of the case, and with the aid of one of the most experienced railroad surgeons in the country, to see that there was no fault with the medical department.

In the six years there were handled 8,964 cases, 240 terminating fatally, 180 capital amputations. Of those terminating fatally 90 per cent were killed instantly. In all of this time we did not find that a "first aid to the injured" system would have been of the slightest value.

The writer is of the opinion that the American trainman is the most resourceful man in the world. If you will not hamper him with instructions not practically understood, and which he is liable to carry out improperly, his common sense will, in almost every case, dictate what should be done; he will usually do of his own volition all that could be expected of a layman under the circumstances.

Wilmington, N. C., April 22, 1903.

ALFRED FOSTER.

The suit commenced at Toledo asking to have the Pennsylvania Company's voluntary relief department declared invalid seems to ignore the fact that the Ohio Supreme Court has recently upheld the validity of the relief department against the claim that the company was exceeding its charter in doing an insurance business. The Toledo suit, brought by the attorney of a woman whose husband was killed, asserts that the company causes the employes to maintain the relief fund in order to save the expense of losses and damages by accident-a narrow view to take of the beneficent work which this provision for the employes' protection has been doing for the past seventeen years, in which time it has distributed about $10,000,000, of which the company contributed $2,500.000.

During the month of January, 1903, the relief department of the Baltimore & Ohio Railroad paid a total of $57,502.31 in benefits, of which $14,000 was on account of accidental deaths; $11,858.05 on account of cases of accidental injury; $1,271.16 for surgical expenses; $16.373.10 for cases of natural sickness and $14,000 for cases of natural death. From May 1, 1880, to January 31, 1903, the department has paid out an aggregate of $7,440,557.11 in benefits. For the month of January, 1903, the relief department of the Pittsburg & Western paid benefits to the amount of $1,486.80, which was apportioned as follows: Accidental injuries, $375; surgical expenses, $24.45; natural sickness, $587.35, and natural deaths, $500. This department has paid an aggregate of $301,849.65 in benefits from January 1, 1894, to January 31, 1903.