Clinics are indispensable to those unable to keep up their knowledge for want of post-graduate opportunities.

It has been on the market for fifteen years and has proven a pronounced success from its very inception.

This number is one of the best of the entire series.

TYSON'S PRACTICE OF MEDICINE, with Special Reference to Diagnosis and Treatment. By JAMES TYSON, M. D., Professor of Medicine in the University of Pennsylvania, and Physician to the Hospital of the University; Physician to the Pennsylvania Hospital, etc. Fourth edition, revised and enlarged. 8vo, cloth, pp. 1,305, with 240 illustrations. Price, $5.00, net. P. Blakiston's Son & Co., Publishers, 1012 Walnut St., Philadelphia, Pa., 1906.

This is by all means the best and leading single volume textbook on the Practice of Medicine. It represents the outcome of a large amount of well directed labor and experience, replete with diagnostic suggestions and with more directions as to treatment thoroughly practical in character than any text-book now extant. For the student and practitioner it is most sincerely and heartily commended.

The work has been very carefully revised for the present edition, and over 60 additional pages of new matter have been incorporated, together with numerous minor changes and corrections throughout the volume, the object being to secure greater accuracy, up-to-dateness, and completeness.

The most important changes will be found in the section on Animal Parasites, which has been revised by the author's colleague, Dr. Allen J. Smith, a recognized authority on this important and practical subject. In addition to the revision, this section has been further improved by the introduction of numerous illustrations, the aim being to make the text plainer, the subject more interesting, and the section the best in its subject.

Selections.

A SIMPLIFIED OPERATION FOR HERNIA IN CHILDREN. Herring (Intercolonial Medical Journal of Australasia) describes an operation for hernia in children which he has devised in accordance with Russell's theory that the presence of the sac is the cause of the hernia, and that the mere excision of the sac in children will result in a permanent cure. Herring calls attention to the fact that the chief difficulty in a hernia operation is the separation of the sac. This is obviated by his method of operating, which is as follows: The incision is made into the sac in the usual position, the contents reduced, and the sac pulled down. The incision in the sac is extended up to the margin of the ring and the upper part of the sac turned inside out, exposing the peritoneal coat, which alone is cut transversely across. As the proximal end edge will retract within the abdomen unless controlled it should be caught in forceps as it is severed. After the peritoneal coat has been separated the proximal part should be closed with catgut and allowed to retract within the abdomen. The wound is closed with subcuticular stitches and sealed. The operation can be done in a few minutes. The ring need not be sutured unless it is large and lax or the patient has a cough. The contents of the inguinal canal are not disturbed. No vessels are cut, so no ligatures are needed. The chances of sepsis are very small.— Charlotte Med. Four.

ACUTE HEMORRHAGIC PANCREATITIS.-C. F. New, Indianapolis (Journal A. M. A., December 30), reports a case of acute hemorrhagic pancreatitis occurring in an insane woman aged 35. The attack began with nausea and vomiting, soon followed by severe epigastric pain and tenderness, requiring opiates and followed later by fever, tympanitis, rigidity and general jaundice. Death occurred suddenly within 36 hours from the onset of the disease. The autopsy revealed the pancreas except a small portion of the head and tail, involved in a soggy mass of coagulated

blood, together with lesions of the liver, kidneys, and spleen, an atheromatous condition of the larger arteries and some fatty degeneration of the heart. The author discusses the symptoms and points out the difficulties of the diagnosis. The pancreas is seldom alone diseased, its functions can be more or less fully performed by other organs, or by a small intact remnant of its own tissues. Still, he says, there are some things that should arouse suspicion of its involvement. Fitz has laid down a rule that when a previously healthy person or sufferer from indigestion is suddenly seized with violent pains in the epigastrium, followed by vomiting and collapse, and within twenty-four hours by a circumscribed epigastric swelling, tympanitis and resistance, with slight rise of temperature, one should suspect acute pancreatitis. The crystals described by Cammadge (see abstract in the Journal A. M. A., July 29, 1905, p. 359) are also claimed to be pathognomonic. The only practical treatment is surgical.

TYPHOID FEVER.-J. F. Jenkins, Tecumseh, Mich. (Journal A. M. A., December 23), insists on the recumbent position from the beginning in typhoid fever. He states that milk preferably given with pepsin and hydrochloric acid, and two soft-boiled eggs every twenty-four hours, occasionally alternating with barley or rice water for a change, makes a very efficient diet during the whole course of the fever. In the later stages a little old whisky, as a stimulant to a flagging pulse may be added to the milk. In the early stages, fractional doses of calomel, followed by a small dose of Rochelle salts or sodium phosphate are indicated; in some cases they may be repeated from time to time during the first and second weeks. Intestinal antiseptics are of value, he states, in checking putrefaction and relieving diarrhea and tympanitis, and, therefore, should be prescribed. When the temperature rises to 102.5°, cold sponging or tubbing should be resorted to, and it is advisable to follow up the bath by vigorous frictions. Frequently a small amount of stimulant is indicated after the bath. When there is delirium or coma the ice bag to the head will relieve and often induce a natural sleep. During convalescence a tepid sponge bath of alcohol and water,

equal parts, he thinks, has a beneficial effect. One should insist on the patient taking from a quart to a quart and a half of boiled water every twenty-four hours as the typhoid patient does not usually demand water, even when the temperature is high. Diarrhea, when excessive, is often checked by reduction or change of diet, and full doses of bismuth subnitrate will usually be effective. For restlessness in the late stages Jenkins has found Hoffman's anodyne a very useful remedy. In the later stage stimulants are required for supporting the feeble heart action, and during convalescence he advises hexamethylenamin in 5 grain doses, 3 times a day, to destroy the bacilli in the urine.

DELAYED AFTER-EFFECTS OF ANESTHETICS.- Every practitioner of medicine is aware of the fact that the evil after-effects of anesthetics, used for surgical purposes, are capable of seriously interfering with the recovery of his patient. Again and again in these columns we have pointed out the fact that although familiarity breeds contempt, the production of anesthesia is by no means a process to be entered into other than reverently, discreetly, and in the fear of God, for without doubt its development is possessed of some danger. Although the immediate dangers of anesthetics are recognized to some extent even by those who are most careless in the use of these drugs, the fact is not so generally recognized as it should be that the use of ether and chloroform is sometimes followed, a number of hours after the operation, by grave symptoms and sometimes by death; this result being largely if not entirely attributable to the drug. For many years surgeons who have been fond of the employment of chloroform have urged upon their doubting brethren that although chloroform was more prone to produce dangerous symptoms during its inhalation than ether, it in reality did not have as high a mortality as does the latter drug, since ether frequently produces pulmonary or renal complications several hours after it has been given. They believe these complications jeopardize the patient's life more than those due to chloroform.

It is well to note that within the last few months a renewed interest has been taken by the profession in this question of postanesthetic accident or illness, and it is also an interesting fact that clinical experience and experimental research have shown that the use of chloroform may be followed by postanesthetic conditions which are exceedingly grave and most difficult to treat. Thus, we find in the Edinburgh Medical Journal for September, 1905, a contribution by Mr. Luke, the Lecturer on Anesthetics at Edinburgh University, in which he discusses postanesthetic sickness. He believes that this sickness depends to some extent upon the nature of the anesthetic employed, the nature of the operation, with special regard to its duration, the degree of skill with which the anesthetic is given, the thoroughness with which the patient is prepared, the patient's condition at the time of the operation, and lastly, the patient's age, sex, and temperament. Our readers will probably recall the results obtained by the Anesthetic Committee of the British Medical Association in 1901, which analyzed 'nearly 22,000 cases of anesthesia. Of these 11.6 per cent. suffered from vomiting after chloroform; 24.7 from this symptom after ether; 15 per cent when nitrous oxide and ether were used: 18 per cent. when the A. C. E. mixture was employed; and 11 per cent. when the chloroform and ether mixture was used. These statistics correspond fairly closely with others collected by individual observers at various times, and Luke sums up the subject by stating that about 15 per cent. suffer from sickness after chloroform, 25 after ether and chloroform, and 40 after ether alone. As Luke points out, however, these statistics are open to the same objection as many other statistics, namely, that they include many cases in which the sickness was so mild that the patient may not have retched more than once, and therefore they do not possess the value that they might have if the records had been kept more accurately.

As to the method of treating postanesthetic nausea Luke believes that the deprivation of fluids, so rigidly enforced by some surgeons, is unnecessary and harmful. He thinks that most drugs have little influence in combating this condition. In his opinion a mustard sinapism applied over the epigastrium is often advisable.