may be compared. It represents three years of original observation on a large number of clinical cases, carefully controlled by a study of the work of other authors not along the same lines, but of such a nature as to afford data bearing upon the correctness of the author's conclusions. It puts new tools into the hand of the diagnostician and, obviously, he must learn to handle them before he can judge of their usefulness. Many probably can never learn to use them-any more than they have been able to use ausculatory percussion, for example.

THE SURGERY OF THE RECTUM FOR PRACTITIONERS, by Sir Frederick Wallis, M. B., B. C., F. R. C. S., London, published by the Oxford University Press, 355 pages, 129 illustrations, $5.50.

to

While the work is essentially surgical, full attention is given clinical details and the work is not surgical in the narrow sense of dealing only with operations. Colitis and sigmoiditis and the extension of venereal diseases are also considered. It is rather a relief to note the absence of of X-ray plates.

PRACTICAL ANATOMY, from the Topographic Standpoint and a guide to dissection. John C. Heisler, M. D., Philadelphia. 366 illustrations, 225 in color by E. F. Faber. 790 pages including a thoroug hindex. Limp leather, $4.50. Published by J. B. Lippincott, Philadelphia.

From the fact that this book comes in a package bearing the advice that the medical student should get another anatomy, we infer that the present book is intended only as a dissecting and operating manual. The arrangement, too, is by regions instead

of

following the anatomic systems and apparatuses. Yet the text is full and, as under the description of certain articulations, the physiology of movement is well discussed. In other words, while not intended to supplant the systematic works on anatomy, it is considerably more than a perfunctory regional treatise.

A MANUAL OF PHARMACY FOR PHYSICIANS, M. F. DeLorme, M. D., Ph. G. L. I. College Hospital, New York. 3d edition, cloth 221 pages, 19 illustrations, $1.25. P. Blakiston's Son & Co., Philadelphia.

ing

This book follows the natural arrangement, discussing the general principles first and then the various official preparations. by Galenical terms. We would suggest that there is no use writa metric prescription which is merely thought out in apothecaries' terms and transposed. The table of Latin words used in prescriptions is complete and should obviate many of the mistakes made through ignorance or carelessness.

MEDICAL DIRECTORY OF NEW YORK, NEW JERSEY AND CONNECTICUT, 1912.

This book, compiled by the State Society, credited for the actual work being modestly withheld, appears in the customary form. The following comparative statistics may be interesting:

These statistics are encouraging as indicating that we have reached a point at which the economic evil of professional oversupply will probably tend to be corrected by natural causes.

The JOURNAL will gladly serve as a bureau for revision of the Directory, for western New York. Glancing through the Buffalo list, we find the names of five physicians who moved away, a year or two ago. It should also be realized that the list-presumably for the entire scope of the directory—includes those licensed to practice. On the one hand, it omits the large number of irregular practitioners who may or may not be considered as competitors. On the whole, our personal experience is that such practitioners rather increase than decrease the work of the regular physician (using the word regular in a broad sense, for the directory is based on legal not ethical status). On the other hand, a considerable number of retired physicians and those engaged in teaching, clerical work, manufacturing, etc., are included. In 1911, the Buffalo list numbered 667, 22 of whom could be immedately excluded on account of death, non-residence, retirement, etc. The list of 1912 numbers 703, 27 of whom may be immediately excluded, besides several married women physicians not in active practice. 4 names should be added.

SULZER'S SHORT SPEECHES. J. B. Ogilvie Publishing Co., 57 Rose St., New York City. 25 cents, paper cover.

We can scarcely review this book without entering a field which a medical journal should carefully avoid but we may say that the versatility of a man in political life is interesting to a profession trained to avoid matters on which they can not work for years and that, irrespective of political views, the thoughts expressed are of interest to the average reader.

ABNORMAL and curious conditions of the vermiform ap

pendix are of so frequent occurence that only the most striking and eccentric usually find their way into the literature.

The occurence of double appendix is so rare as to cast doubt on the few cases reported. Absent appendix can be accounted for on morphologic grounds as well as through the accidents of previous disease. The writer once assisted at an operation where, even after enlargement of the incision and painstaking search, by a careful surgeon, of an otherwise normal caecum, no sign of any appendix was found save a small conical protrusion of the gut where the appendix should have been.

Some two years ago in a notorious book on the troubles and failures of the medical profession there was cited a case since often repeated with gusto by laymen. A surgeon having, as he thought removed the appendix of a certain certain patient, was chagrined on seeing a colleague later remove an appendix from the same patient. That this story need not reflect on the ability of surgeon No. 1, the following instances will tend to prove. These are not intended as case reports but conditions observed by the writer in his own experience and in his hospital service as

interne.

(Fig 1.) This patient had two years previously an appendix abscess which was incised and drained. At the second operation the distal end of the appendix was found attached like a captive dirigible baloon by a thin mesappendix to a short proximal stump under adhesions. This stump need have been only a trifle longer to have made possible a second appendicitis. The writer marvels, that the apparently normal, though somewhat atrophic mucosa within the free portion, had not distended it with secretion as has been shown to occur in an excluded closed loop of gut.

(Fig. 2.) This represents a type in which the proximal end of the appendix lies retrocaecal. The writer has seen a second rate surgeon leave behind the retrocaecal one-third of such an ap

pendix through use of the absolute method of simple ligation of the appendix leaving uncovered the cauterized stump. Investigation would have disclosed the base.

(Fig 3.) This patient was operated on in extremis with peritonitis, by a most capable surgeon. At a secondary operation

by the same man for adhesions, remnants of an appendix were removed from dense adhesions. At a third operation for ileocaecal obstruction the writer found one and one-fourth inches

of appendix distally adherent to the drainage scar in the abdominal wall,

These experiences confirm the value of burial of the appendix stump in the caecal wall and afford an explanation for some cases of apparent but not actual removal of the appendix. 471 Viriginia Street.

7ITHIN a comparatively recent period, it has been noted that physicians are called on, with increasing frequency, to treat persons who are intoxicated or suffering from some disorder that has followed the excessive use of spirits.

Often these persons are from the best families and among those who are the warmest patrons of the physician. They are suffering from delusional states, have defects of vision and hearing and other conditions which they realize are the results from spirit drinking, and turn to the physician with pathetic eagerness for help. They are alarmed, mortified and excited and this is increased by the anxiety of relatives and friends.

The physician is often distressed at the impotency of his efforts and is in doubt as to the best methods and means to be used. If he gives opium or its alkaloids, there will be stupor, following delirium, and not unfrequently narcotism with the possibility of fatal termination.

When this occurs his anxiety is increased with the thought that the narcotic was the most active cause. If he tries emetics