The Circulation of Tissue Fluid in Man.-From the observations of Geo. Oliver, the following facts are brought out: (1) The amount of tissue lymph varies during the day and each variation is of short duration. (2) The injection of food causes a rapid flow into the lymph spaces. (3) The digestive curve of variation follows a uniform rule of rapid rise, short acme and gradual subsidence. (4) As the digestive lymph wave develops, there is a rise in the percentage of cells, hæmoglobin and specific gravity of the blood. (5) As the digestive wave declines, there is a corresponding decline in all three. The general office of the intermediary lymph circulation is a three-fold one: (1) It provides the mechanism, as it were, for the supply of pabulum to the tissues and for the removal of soluble waste products from them. (2) The lymph wave which follows a meal insures the immediate supply of pabulum from the blood which restores all the tissues of the body at once and long before the food itself can be assimilated into the blood. Thus it is that the ingestion of food secures the speedy renewal of the energies, which is a matter of common experience; and therefore the exhausted tissues have not to remain unsupplied with fresh nourishment until the food taken becomes part of the common store of pabulum which the blood keeps ready for distribution. (3) Beverages (tea, coffee, alcohol) probably invigorate the body by inciting a flow of lymph into the tissues. Beverages, however, viewed from this standpoint, differ from foodstuffs in that they fail to restore to the blood the outflow of pabulum they create. They are therefore but temporary expedients of nutrition. The author believes that these views may have a bearing in gout, for he is convinced that it depends on a derangement of the intermediary circulation, and that therefore the tissues themselves form the arena in which gouty disturbances develop and manifest themselves. Residua may accumulate and be deposited in the interstitial spaces of the tissues, because their removal is thwarted, either by an excessive capillary blood-pressure limiting the absorption of fluid from these spaces or by a diminution of that pressure reducing the fluid exchange between the blood and the tissues. Hence the two leading types of gout which are well recognized. According to the author's observation, the continuous presence of a large quantity of tissue lymph provides an important condition for the development of the local manifestations of gout, which were present in by far the majority of the cases observed, and those few cases in which local signs of gout had not so far declared themselves might fairly be said to be gouty -in the sense of potential gout.

British Medical Journal, October 3, 1903. Poisonous Effects of Ricinus Communis.-W. J. Burroughs reports a case of poisoning from castor-oil seeds. The patient was a man of fifty years. Soon after eating two of these seeds he was seized with symptoms of poisoning. The contents of his stomach were evacuated and he was greatly relieved. The next day he felt comparatively well. The seeds were proved to be castor-oil beans. They were rather dried-up specimens.

On the Nature of Fragilitas Ossium in the Insane.-W. Maule Smith presents a valuable paper on this subject. He gives the results of an analysis of 200 cases from the post-mortem records of the Wakefield Asylum. There were 27 cases of idiocy or imbecility between the ages of 6 and 78. Excepting one case, no fragility occurred until after the 40th year. The exception was a male of 26 years, in whom the condition was slightly present. Of patients dying after 40, fragility was present in 8 and absent in 3. Of the 8 cases 4 were males and 4 were females; of the 3, one was a male and 2 were females. Eighteen patients died of chronic mania. No fragility occurred up to the age of 44. After this age it was absent in only 2 males. Seventeen patients died suffering from chronic melancholia. Brittleness was absent in only 2. It was always slight in the males but marked in the females. In the cases of general paralysis, only 3 males out of 25 cases showed pronounced fragility. In 11 out of 14 females this change was very pronounced. The percentage of cases of dementia is the highest, those of epilepsy the lowest. The disease is more frequent in the female sex and occurs at an earlier age than in the male. It is comparatively rare before the ages of 45 or 50, except in general paralysis. It is essentially a morbid change, which occurs in late middle life and old age.

Preliminary Note on the Action of the Blood Serum from Subjects of Mental Disease on B. Coli Communis.-A. V. Johnson and E. Goodall present the following summary: Good agglutination shown in four out of five cases of acute melancholia, one out of three cases of general paralysis of the insane, one out of two cases of delusional insanity. and in one case of climacteric insanity. Partial agglutina

tion shown in six out of eleven cases of acute mania, one out of two cases of delusional insanity, and one case of

alcoholic insanity. No agglutination in five cases of mania, one of melancholia, one of puerperal insanity, two of general paralysis, and one case of recurrent mania. The agglutination is present in 60 per cent. of all cases, 28 per cent. good agglutination, 32 per cent. partial agglutination; only one control showed a slight partial agglutination. The greatest number of both good and partial agglutinations were obtained from a virulent culture of B. coli communis with a dilution of 1 in 100. Another interesting point that is being investigated is the leucocyte count in various forms of insanity. The white cells are found to be in much greater numbers when the patients are passing through acute states, running then as high as from 30,000 to 40,000 per one c. mm. of blood, and falling again to 15,000 and 10,000 during stages of remission and in cases of recovery.

Deutsche medicinische Wochenschrift, September 17, 1903.

Spread of Diphtheria.-K. E. Büsing shows how nurses may disseminate diphtheria. A nurse employed in a child's hospital into which contagious diseases were never received, complained of sore throat on March 11, but remained upon duty until March 24, when a culture was taken from her throat, the bacteriological examination of which showed the presence of diphtheria bacilli. Three of the children whom she was attending sickened of diphtheria on March 16, 22, and 27, respectively. All other sources of contamination were excluded.

Physiological Action and Pharmacodynamics of Silicic Acid. H Schulz thinks that silicic acid is an important ingredient of certain of the body tissues, and that as a therapeutic agent it possesses a greater degree of activity than has been hitherto supposed. By analysis it may be found in many of the body tissues, and is especially abundant in those which are particularly rich in connective tissue, such as the tendons and fascia. Indeed extended observations show that it is an important and essential constituent of connective tissue, holding thereto a similar relation as phosphorus to nerve tissue. It is interesting to note that in the lower animals and in young human beings silicic acid is very much more abundant than in human adults. The reason for this is not entirely clear. It is known, however, that in certain organic combinations the silicon may be replaced by carbon, giving rise to carbon compounds. It may be supposed that the silicon compounds are especially abundant in the lower animals and young adults, but that in human beings, as age advances, the silicon is replaced by carbon and the quantity of silicic acid in the tissues correspondingly decreases. The feeding of silicic acid in large quantities to healthy men shows that it is by no means a negative substance. It produces no symptoms in the respiratory, circulatory, or lymphatic systems, but it gives rise to irritability of the nervous system, digestive disturbances, cutaneous eruptions, and a peculiar feeling of weight and stiffness in the extremities. Also at times the joints become painful and swollen.

Berliner klinische Wochenschrift, September 21, 1903. Vegetable Nutrition and Drinks in Gout and Nephritis.J. Walker Hall shows that many vegetables and grains, such as potatoes, beans, oats, and asparagus, contain a considerable amount of the purin bases. Also that the same are abundant in various brands of beer and porter. These substances should, therefore, be limited or excluded from the diet in gout and nephritis.

Hysterical Autosuggestion of Children.-C. A. Ewald describes three cases of a hysterical nature in which the nervous symptoms were produced by local irritation. In the first case the child had swallowed a bone and complained that it had lodged in the intestine The boy pointed out the tender spot, which was in the left iliac region, and upon pressure over the region there was elicited marked pain and tenderness. No resistance or tumor, however, could be detected. Upon suitable hysterical treatment all the symptoms vanished. The second case might be designated as "hysterical appendicitis." This likewise succumbed to similar treatment. The third case was characterized by violent hysterical attacks, the cause being cerebral irritation due to overstudy.

Action of Bile upon the Heart and the Cause of the Retarded Pulse Rate in Jaundice.-Kurt Brandenburg by a series of experiments upon animals shows that a small amount of bile introduced into the circulation irritates the nerves of sensation of the heart, and in this manner by reflex action through the vagus produces a retardation of the heart's action. If large quantities of bile are introduced it acts directly upon the cardiac muscle showing the heart's beat and if the quantity of bile be large enough, completely paralyzing its action. The biliary acids are the constituents of the bile which produce this In jaundice it is probable that both of the above

effect.

given at this time, as the writer had been obliged to return the tube of radium to Professor Baskerville.

The pelvic case had been under care for three months and has improved to date under the combined influence of the x-ray (internal applications entirely) and ultraviolet light. Infiltration of vaginal walls is largely absorbed, hemorrhage under control, discharge also and the foul odor has entirely disappeared. Healing has taken place in the ulcerated area involving the cervix and the right posterior fornix. The patient's general condition is much improved, there is no characteristic pain, no cachexia, no loss of weight, her functions are well performed and she eats and sleeps well. There is, however, a discharge of blood from the rectum upon defecation and now and then at other times. Because of this, and believing that the radium rays would penetrate more deeply than the x-ray, the radium was used.

Prior to its use a physical examination was made showing elastic vaginal and rectal walls, no bleeding from the manipulation, no discharge, no odor, no ulcerated tissue, no pain, but the cervix uteri and adjacent vagina through the glass water-jacket of a vaginal x-ray tube, inserted to contain the tube of radium, were seen to be intensely congested, just ready to bleed, and streaks of blood were numerous, especially from the right fornix and posteriorly. this water-jacket, closed at its distal end, the tube containing the radium bromide was placed and allowed to lie on the posterior surface of the waterjacket for five minutes. It was then held five minutes more near the anterior surface of the tube, because of the vesical involvement.

In

September 16, 1903, the cervix uteri was found to be completely blanched and also the vaginal walls, with here and there tiny little punctate spots of bright red, not larger than the smallest pin head. There was no discharge, no odor, and no pain. The writer questioned the advisability of making another exposure at this time, but as it was the only opportunity of doing so before returning the radium to Professor Baskerville, a five-minute application was nade as before.

September 18, 1903. Speculum examination showed the cervix uteri and vagina intensely conrested and bleeding; no treatment given. It is vident from the reaction that a mistake was made in eapplying the radium in this case on the second day. September 21, 1903. Five days subsequent to he use of radium, no bleeding, no odor, no discharge, to ulceration, and vaginal and cervical mucous memrane normal in appearance. General condition ood, but complaining of some vague discomfort, hich may be attributed to the fact that her occuation necessitates much standing and walking. here has been no bleeding from the rectum since he radium was used.*

This report is made because, taken in connection ith the experience of others, it seems to forehadow an important place in medicine for radium. he writer offers no opinion as to the outcome of hese two cases. They will be carefully watched nd ultimately reported. The technique evolved given, in the absence of any knowledge on the ibject. It may not stand the test of time. Fur1er experience can only prove this. There is osolutely no guide for the therapeutic applications radium, and the writer preferred to err on the de of least danger to the patient. The profound hysiologic action obtained would seem to indicate at the more powerful activities and long ex>sures are not necessary. *September 28. Is looking and feeling well. No mptoms; still no bleeding from rectum since radium first ed, two weeks since.

Of the three sets of rays in radium "A,” “B,” and "R" evidence points to the identity of the "A" ray with the Röntgen or x-ray, in the matter of penetrating opaque bodies. This and subsequent facts suggest to the writer's mind, a corroboration of the position taken by the Drs. Shields,' that it is not the x-ray, but the cathode ray which establishes physiological action and secures a therapeutic effect. To x-rays however produced, whether from an excited x-ray tube or a radium salt, the power of penetration of opaque bodies is then due. In the "B" rays a higher vibration is reached analogous to the cathode rays, while in the "R" rays a still higher degree of vibration is attained, capable of a more powerful chemical action and profounder physiological effect. This is what we seek in combating diseases of the nature of cancer. In a daily experience with these cases the writer has come to feel that if a higher, more penetrative and a more active chemically disorganizing vibration than is obtained from an x-ray tube could be applied, in a lethal dose, to the cancer cells, better results would necessarily accrue. So much is accomplished with the x-ray that one can but feel that an energy of the same kind, but of greater intensity, would do more. In establishing the treatment by means of radium rays the purpose would be best met by a full dose, whatever that proves to be, in order to act destructively upon the foci of disease.

The fact that radium emits rays of a greater penetrating power and of a higher vibration than the cathode rays, i.e. the "R" rays taken in connection with the change in appearance and relief obtained in the writer's case of sarcoma and the cure of the cases reported, stimulates the hope that in radium a therapeutic measure of value over and above the x-rays is at command. In the case of sarcoma the best resources of excited x-ray tubes has been faithfully tried, even to the production of an x-ray dermatitis, but up to the time of the use of the radium he was rapidly losing ground. Unless radium should prove for him an Aladdin's Lamp of more than fabled power, he is doomed.

There are submitted herewith two tubes of radium bromide, one containing a decigram of 3,000 and the other a gram of 7,000 radioactivity. At night, in the dark, they look like glow-worms as they lie on my study table. They can be placed within the accessible mucous cavities, according to the location of the disease, within the nose, uterus, or urethra, and a device could unquestionably be constructed permitting the placing of one in the œsophagus or stomach even, if it is found that a mucous membrane contact is the better one. In breast cancer a puncture could be made with the electrocautery, in order to secure a bloodless opening, and the tube could be carried directly within the malignant mass.

To the over-tired x-ray machine and tube worker, the thought of securing the same, and perhaps better, results with one of these quiet, inoffensive, and unaggressive tubes of radium salt is entrancing. The use of radium can never be common, not alone on account of the initial expense, but because of its scarcity. The tube with which the writer's work has been done is valued at $200. Future work will be done with the same radioactivity.

Just here, as showing not only the unity of scientific interest but the universality of humanitarianism, is appended a letter received from Professor Baskerville on the 21st.

MY DEAR DOCTOR: . . . I am very glad you kept the ra. dium long enough to make some use of it, and I wish to say right now that while I wanted it here and shall need

operation is impossible, for one reason or another. It gives good results in chronic iridochoroiditis, and in retinal hemorrhages. It has an anesthetic action in cases of cauterization, and its application greatly assists in many surgical operations on the eye.-Recueil d'Ophthalmologie, August, 1903

Narcosis by Means of the Chloride of Ethyl.-Filippo Carta has used this substance for narcosis in cases of minor surgical operations in pleurotomy with resection of the ribs in the enucleation of glands, the reduction of luxation of the elbow, paracentesis of the membrana tympani, etc. He considers it an excellent anæsthetic in all interventions of short duration. It is well supported in cases in which chloroform and ether would be dangerous (circulatory disorders, fatty degeneration of the heart, diseases of the respiratory tract, cachexia, hemorrhages, grave traumatism). Complete unconsciousness occurs in from a minute and a half to two minutes. A return to normal occurs a few seconds after the mask is removed. In major operations it is not prudent to use this remedy, as it has not as yet been determined what possible lesions may be produced on the visceral organs by large amounts of chloride. In mixed anææsthesia the chloride of ethyl eliminates the long and dangerous period preceding anæsthesia.-Giornale Medico del Regio Esercito, August

31, 1903

Death and Accidents Due to the Dependent Position in Abdominal Surgery.-F. Jayle holds that the Trendelenburg When there position is responsible for many casualities. is any cardiac lesion, the extra strain put upon the heart may bring about a fatal result, or leave a weakness which will later cause death. In such patients, as well as in those suffering from obesity. atheroma or ascitis, the right side of the heart is the one chiefly affected; this occasions congestion of the lungs, sometimes resulting fatally. Moreover, as the dependent position causes, depletion of the pelvic veins, hæmostasis may appear to be complete, and oozing follow a return to a normal position. Another occurrence of less grave import, is the possible entrance and retention of air in the abdominal cavity. The intestines fall back against the diaphragm, leaving the pelvic cavity free, and unless the patient is lifted back into an upright posture during the operation, and the iliac fossæ pressed upon to expel the air, some of it will be imprisoned and cause painful subcutaneous emphysema. Partial paralysis of the lower limbs may occur from the Trendelenburg position, but can be avoided by the application of suspension bandages to the shoulders and other parts of the body.-La Presse Médicale, September 16, 1903. Traumatic Rupture of the Small Intestines.--Charles Juilliard believes in exploratory laparotomy in doubtful cases. He also gives points for the diagnosis between contusion and rupture of the intestines. To avoid peritonitis there are two measures: The first, whose value will be clearly demonstrated in the future, consists in strengthening the resistance of the organism against infection by increasing phagocytosis, and this by means of the injection of special serums. The second consists in clearing the peritoneum of septic matter. To accomplish this, physiological serum, at a temperature of about 98.6° F. should be poured into the abdominal cavity in large amounts until from thirty to sixty quarts have been in contact with the peritoneum. Without being actually brusque, a certain force must be given to the fluid, as the mechanical action is the chief advantage of the procedure. The fluid should be made to spread by slightly shaking the loops of intestine. When the fluid returns perfectly clear and the peritoneum appears to be clean, the washing may be stopped. This treatment is well borne by the patient, and the tendency to shock is overcome. The pulse increases in frequency and in fulness. inaccessible to tampons can be reached by these washings. They are contraindicated in cases of localized infection in which the rupture of adhesions and diffusion of septic matters in a non-septic peritoneum is to be feared.— Revue Médicale de la Suisse Romande, September 20, 1903.

Parts

Intestinal Lithiasis.-N. Van De Velde-Coosemans discusses this disease, citing a number of cases. In the matter of treatment, the first symptom to combat is pain. This may be overcome by hot abdominal compresses, or laudanum poultices. Morphine may have to be given hypodermically. At the same time the intestines should be washed out with glycerinated water. Should the latter cause the evacuation of copious stools with much sand, the crisis will be terminated, but an irritable and painful condition of the intestines will remain, which should be treated by oily lavements at first, later by copious washings with water containing some medicament, such as the biborate of sodium, which is antiseptic and non-irritating. The use of intestinal washings should not be abused: the physician himself should administer them according to indications, and he should exercise extreme care as to the

temperature, the amount of water and the pressure. Belladonna should be pushed to pupillary dilatation and dryness of the throat. The crisis over, treatment should be directed to the prevention of its recurrence, and this is effected by treating the mucomembranous colitis. Tact and patience will be required, for the affection is extremely stubborn. It is always preceded or accompanied by a special condition of the gastric secretions. Diet and hygiene are of the utmost importance in the treatment.Société Médico-Chirurgicale d' Anvers, July-August, 1903. Intestinal Cancer in Youth.-E. Saint-Jacques and L. Parizeau report the case of a boy of eleven years who was brought to the hospital because of incoercible vomiting and distended abdomen. Pulse was 110, temperature normal. Other treatment proving of no use, laparotomy was resorted to and an epithelial cancer removed from the sigmoid flexure. The child died of shock. From a study of this and other cases the author concludes that intestinal cancer often develops insidiously, giving no other symptom than chronic dyspepsia, and causes a sudden crisis of intestinal occlusion without premonitory warning. It is met with in youth more often than in adult life. Laparotomy should be resorted to if medical treatment be of no avail.-L'Union Médicale du Canada, September, 1903.

Rapid Atrophy of the Large Cirrhotic Liver in Infections. -M. Marcou treats of the care of persons who eat heartily, drink constantly (without being absolutely alcoholics), and exercise little; who are apparently in perfect health and yet have hypertrophied livers. Cirrhosis follows in the course of time. The author calls these cases of toxialimentary hypertrophic cirrhosis. In overnourished, rich patients, the hypertrophy represents a compensatory activity of the cells, and may be prolonged indefinitely if the patient can be brought to realize the necessity of care. In the poor man who is insufficiently nourished and drinks poor alcohol, cirrhosis occurs at once. Yet, even in the former case, should a grave infection occur, the liver is unequal to the strain, atrophy may occur with rapidity, or the patient may recover and the liver undergo a slow process of sclerosis. In any case a fatal end is inevitable.-Archives Générales de Médecine, September 8,

A SURGICAL HANDBOOK. By FRANCIS M. CAIRD, M.B., and CHAS. W. CATHCART, M.B. Twelfth edition. 16m0, 323 pages. Illustrated. Chas. Griffin & Co., Ltd., London.

DISEASES OF THE SKIN. By MALCOLM MORRIS. New edition. I 2mo. 642 pages. Illustrated. W. T. Keener & Co., Chicago.

MODERN MICROSCOPY, A HAND BOOK FOR BEGINNERS AND STUDENTS. By M. I. CROSS and MARTIN J. COLE. Third edition. 8vo, 292 pages. Illustrated. W. T. Keener & Co., Chicago.

DISEASES OF THE URINARY ORGANS, INCLUDING DIABETES MELLITUS AND INSIPIDUS. By CLIFFORD MITCHELL, M.D. 8vo, 716 pages. Illustrated. Boericke & Tafel, Philadelphia, Pa. ́Price, $4.00 net. TRANSACTIONS OF THE AMERICAN PEDIATRIC SOCIETY, FOURTEENTH SESSION. By WALTER LESTER CARR, M.D 8vo, 310 pages. Illustrated.

TRANSACTIONS OF THE TWENTY-FIFTH ANNUAL MEETIHG OF THE AMERICAN LARYNGOLOGICAL ASSOCIATION at Washington, D. C., 1993. 8vo, 292 pages. Illustrated. NOSE AND THROAT WORK FOR THE GENERAL PRAC TITIONER. By GEORGE L. RICHARDS, M.D. 8vo 330 pages. Illustrated. International Journal of Surgery Company. New York. Price, $2.00.

ADENO-MYOME DES UTERUS. BY THOMAS S. CULLER. 4to, 91 pages. Illustrated. August Hirschwald, Berlin. Germany.

FUNCTIONAL DIAGNOSIS OF KIDNEY DISEASE WITH SPECIAL REFERENCE TO RENAL SURGERY By Drs. LEOPOLD CASPER and PAUL F. RICHTER. 8 vo, 233 pages. P. Blakiston's Son & Co., Philadelphia Price, $1.50 net. MEDICINISCHER LAGER-KATALOG, No. IV. INNERE MEDICIN. Hirschwaldschen Buchhandlung, Berlin.

THE PRINCIPLES AND PRACTICE OF HYDROTHERAPY, A GUIDE TO THE APPLICATION OF WATER IN DISEASE. By SIMON BARUCH, M.D. Second edition. 8vo, 296 pages. Illustrate. William Wood & Co., New York. Price, muslin, $4.00 net.

Book Reviews.

A TEXTBOOK ON THE PRACTICE OF MEDICINE. Designed for the Use of Students. By JAMES MAGOFFIN FRENCH, M.D., Lecturer on the Theory and Practice of Medicine, Medical College of Ohio; Attending Physician St. Mary's Hospital; Consulting Physician St. Francis' Hospital for Incurables, Cincinnati. Illustrated by Ten Full-page Plates and Fifty Wood Engravings New York: William Wood & Co, 1903.

THIS is a book out of the ordinary, in that it modestly professes to be only for the use of students and lays no claim to be a guide for practitioners. That it is well adapted to fulfil its professed object one is bound to confess, for its style is simple and suited to the comprehension of one who is only beginning his medical life, and is not yet familiar with the difficult language of his future profession; the definitions are clear and expressed in terms of easy comprehension, and each subject is treated of from the standpoint of one who knows the needs of the beginner, of the student who has everything to learn, and not from the superior level of the scientist who assumes that his readers are versed in all but the very highest branches, and who often, therefore, writes above the intellectual grasp of those who would learn from him. But withal, this is not a child's book. The language is simple and the style is lucid, but the teaching is sound and comprehensive; the book is up to date, and includes not only a statement of the facts of medicine, but also a presentation of the most acceptable theories. It seems to us, therefore, equally adapted to the uses of the practitioner, who has not the time or the inclination to study the larger treatises, but who wants the latest teaching on any particular subject in the fewest words.

The first fifty pages of the book are given to an introduction into the first principles of medical science, or a sort of running dictionary in which all the frequently recurring terms are defined and explained. In this part also the various morbid processes are described-fever, inflammation, degeneration, regeneration, etc., and a general statement is presented of the action of bacteria in the causation of disease.

In Part II, which constitutes the main portion of the work, the author presents a systematic treatise on the practice of medicine, describing under the usual heads of etiology, morbid anatomy, symptoms, treatment, etc., all of the ordinary and many of the rarer diseases which the physician may be called upon to treat, and of which the student must have knowledge in order to fit himself for the practice of his profession.

The book closes with a section describing the usual methods of clinical examination, including formulas for the reagents and test solutions employed in examination of the urine, stomach contents, blood, etc. Finally a very complete index facilitates reference to any subject treated of in the work.

Students generally will find this a most serviceable textbook and one which will admirably supplement the teaching received in their didactic and clinical courses. Practitioners also, especially those who have been too busy to follow closely the rapid advances of modern medicine, will find in these pages all that is needed to familiarize them with the latest accepted teachings of their science.

DIE GONORRHOE DES MANNES UND IHRE KOMPLICATIONEN. Von HANS WOSSIDLO, Berlin: Otto Enslein, 1903.

In this work the author, as in his previous book on stricture, avows himself a firm partisan of the dilatation treatment in chronic gonorrhoea, as first laid down by Oberländer. And also, as does Oberländer, Wossidlo urges the need of urethroscopy to furnish an intelligent guide for the treatment of chronic urethral disease. The book is singularly free from extensive theoretical considerations, which so often encumber German practical works; its language, moreover, in its terse sentences not only reveals the author to be an English scholar, but makes his work the more acceptable to those whose German is acquired. In this book Wossidlo covers the most modern methods of gonorrhoeal therapeutics in a decidedly practical form. Forty-four illustrations in the text well depict the essentials, while the most important lessons in urethroscopy are imparted by twenty-four superb chromolithographs. These were made from originals done in oil by the author's former assistant, Dr. Schramm, and will be welcomed by all who hitherto have had to content themselves with mainly schematic representations, or under colored or overcolored tints. The tone in which the book is written will make it valued primarily by the large number of American, English, and colonial physicians who have taken courses at the author's "Poliklinik." It will bring him to mind "wie er leibt und lebt," simple, unaffected, non-polemical, but always practical

and convincing. These same qualities, evident in every line of this book will create favor for it among all those who must contend with the intricacies of this disease, from uncomplicated anterior gonorrhoea to its most serious and remote complications and sequelæ. THE AMERICAN ILLUSTRATED MEDICAL DICTIONARY. A New and Complete Dictionary of the Terms Used in Medicine, Surgery, Dentistry, Pharmacy, Chemistry, and the Kindred Branches, with Their Pronunciation, Derivation, and Definition, Including Much Collateral Information of an Encyclopedic Character. By W. A. NEWMAN DORLAND, A.M., M.D., Assistant Obstetrician to the University of Pennsylvania Hospital; Editor of the American Pocket Medical Dictionary; Fellow of the American Academy of Medicine. Third edition. Revised and enlarged. Philadelphia, New York, London: W. B. Saunders & Company, 1903.

In this edition of Dorland's excellent dictionary new matter has been added to bring the book up to date and keep it in line with the constant multiplication of medical terms. Some of the tables, the least commendable feature of the work, have also been enlarged. We do not notice any addition to the illustrations To those who know this work, no words of commendation are needed; to those who do not, it will suffice to say that the book is a very serviceable one, owing to its comparatively small size, flexible binding, and clear type. The worst quarrel we have with it is on account of the numerous tables which. we consider no addition to a dictionary. If they must be used they should be placed in an appendix where they can be consulted by the curious, but whence they cannot come to thrust their unwelcome presence in the face of the man who is looking for the definition of a word and not for a treatise on anatomy or chemistry or bacteriology. However, it seems to be the fashion with dictionary-makers to use them. In all other respects this dictionary is most commendable.

A LABORATORY GUIDE IN URINALYSIS AND TOXICOLOGY. By R. A. WITTHAUS, M.D., Professor of Chemistry, Physics, and Toxicology in the Medical Department of Cornell University. Fifth edition. New York: William Wood & Co., 1903.

A BOOK which has reached its fifth edition hardly needs a very extended notice. The one under review is well named a "laboratory guide," for every page smacks of the laboratory and of the practical side of analysis. It is, however, much more than a mere guide to uranalysis, for the first forty-five pages present a fairly extensive course in inorganic analysis, and the last twenty-seven pages treat of toxicology. Having learned, practically, the meaning of chemical analysis, the student is successively taught qualitative and quantitative analysis of the urine, and the analysis of urinary deposits and calculi. Accuracy is the watchword throughout, and so rigorously is everything excluded which cannot come up to the high standard set by the trained analytical chemist, that the clinician will look in vain for several of his familiar methods. The instruction is so clear and explicit that "he who runs may read," a fact which is, perhaps, nowhere better shown than in the apparently trite subject of the heat and nitric-acid test for albumin; indeed, the perusal of these few short paragraphs would well repay many a well-informed physician.

EYE SYMPTOMS AS AIDS IN DIAGNOSIS. By EDWARD MAGENNIS, M.D., D. P. H., late Clinical Assistant at the Royal London Ophthalmic Hospital; Author of "The Eyesight of School Children," Hygiene in the Schoolroom,' Healthy House Sites," "The Irish Poor Law System," etc. Bristol: John Wright & Co. London: Simpkin, Marshall, Hamilton, Kent & Co., 1993. IN this little book the author has gathered into easily accessible form a presentation of whatever there is for the general practitioner to learn regarding systemic as well as local diseases from a careful observation of the special symptoms connected with the eye itself. Nothing is at times more puzzling than to determine to one's own satisfaction the precise morbid condition present in a special case, and however great may be one's knowledge derived from reading as well as from experience, atypical cases will constantly present themselves, the new features and irregular symptoms of which will baffle the most skilful interpreter of morbid signs. The need, therefore, of taking advantage of every aid in arriving at a correct diagnosis is apparent. The eye does not reflect every morbid process going on in the body, but it does betray many, and the accessibility of this organ and the transparency of most of its structures make a study of it, as the author says, both interesting and satisfactory. This is a very small book, almost a "vest pocket” edition of about one hundred pages, but the author possesses the art of condensation without sacrifice of lucidity, and he has succeeded in compressing much useful information within its compass.

and the picture of the folds of the mucous membrane are altered so that a more or less swollen lumen of the urethral canal can be noted. If the chronic gonorrhoeal inflammation has developed a stricture then the urethra assumes the form of a canal, and its form will vary according to the contraction of the various structural changes. On endoscopic examination a stricture has the form of a small hole or gaping cleft with non-elastic walls of variable forms, as shown in Figure 7.

FIG. 7.

It is possible to classify a number of certain anatomical types of stricture: (1) Often the stricture is cylindrical; (2) More often still it is funnel-shaped; (3) In many cases it is in the form of a ring embracing the whole circumference of the urethra; (4) The half-ring formation is more common. Aside from the forms mentioned there are a great many irregular forms that cannot be grouped in any of the above divisions.

When, as is often, the case multiple strictures are formed, they generally belong at first to the same variety, but they soon become differentiated in form.

By small cicatricial alterations the urethra loses its elasticity, and in extreme cases it is scarcely possible to see the opening with the naked eye.

The axis of the stricture is not always in the same plane as the axis of the urethra. A stricture can follow a winding course and then have various axes. The opening of the strictured canal is not always in the middle of field of vision; it lies very often excentrically. The length of the stricture is generally not marked; it depends upon the amount of tissue involved in the pathological process that caused it. However, the length of gonorrhoeal strictures is seldom greater than one centimeter.

The number of strictures in the urethra are dependent on their etiological cause. While traumatic strictures are single, gonorrhoeal strictures on the contrary are often multiple. However, it is rare that more than three strictures can be found in the urethra.

The position of the stricture is dependent upon the situation of the pathological process that caused it. The traumatic stricture develops where the urethra was torn. As wounds which lead to tears of the urethra occur mostly in the region of the perineum, traumatic strictures occur most often in this location.

The gonorrhoeal strictures develop in the place or places where the chronic inflammatory process has reached its greatest intensity.

Sir Henry Thompson investigated 320 anatomical preparations in order to find out the most frequent position of gonorrhoeal strictures. For the purpose

of classification he divided the urethra into three divisions.

1. Embraces the region of transition between the bulbous and membranous parts, embracing 2.5 centimeters in front, 1.8 centimeters behind this line of division.

2. From the forward boundary of the first division to 6.3 centimeters from the meatus.

3. From the meatus externus to 6.3 centimeters or to the forward boundary of division 2.

The strictures are divided into these arbitrary divisions, according to Thompson, as follows: Total number of strictures, 320. In region 1, 215, or 67 per cent; in region 2, 51, or 16 per cent; in region 3, 54, or 17 per cent. Of these, 185 had only one stricture in region 1; 17 had only one stricture in region 2; 34 had only one stricture in region 3. It was found that there were 8 cases in which all three regions were strictured, 10 cases in which strictures were found in regions 1 and 2, 10 cases in which strictures were found in regions 1 and 3, 10 cases in which strictures were found in regions 2 and 3.

Thompson ascertained that in the museums of London, Edinburgh, and Paris there were only two specimens of stricture of the prostatic urethra.

Rollet gives the following measurements of the dilatability for the different parts of the male urethra. Orifice, 7-8 mm., 21-24 Charrière; fossa navicularis, 10-11 mm., 30-33; behind the latter, 9 mm., 27; middle of pars cavernosa, 10 mm., 30; bulb, 12 mm., 36; pars membranacea (middle), 10 mm., 27; pars prostatica (beginning), 10 mm., 30: middle of same, 15 mm., 45; posterior part of same,

II mm., 33.

Thus it can be seen that next to the orifice the bulbo-membranous junction is one of the least dilatable parts of the urethra.

Endoscopy has, however, taught us that there are a much greater number of intensely chronic inflammatory changes of hard infiltrated formation in the pars anterior than were formerly recognized.

From the above-mentioned figures of the dilata bility of the urethra it can be seen that we cannot rule out the presence of a stricture in cases in which a sound 16-20 Charrière has been passed easily through the urethra.

In the anterior portion of the urethra we find a great many strictures of wide caliber as shown by Otis. Finger in his monograph on this subject has pointed out the importance of recognizing these stric tures of large caliber at an early date in their forma tion, as an important aid to preventive treatment.

Passing now to the macroscopical examination of the changes caused by cicatricial tissue, we find important periurethral changes. The section of mu cous membrane is much thicker in the location a the stricture, whiter and harder than in the other parts of the urethra. There no longer exists any sharply marked boundary between the mucous membrane and the corpus cavernosum. In severe cases the mucosa and the corpus cavernosum are changed into a hard callus. The cavernous connective tissue has lost its normal appearance. It appears homogeneously hard, of an equally pale color, atrophied and sclerosed. The normal vascolarization has disappeared to a greater or less extent on the surface. Microscopically we find a change in the strictured urethra in the form of an alteration of its epithelium.

In the first grade of inflammation we find epithelia alterations, consisting of a thickening, swelling, and partial desquamation. The epithelium has a tend ency to change from the normal cylinder epithelium into pavement epithelium.

Finger has differentiated three types of pavemest epithelium. (a) It resembles that of mucous menbranes with pavement epithelium, i.e. it consists of an undermost layer of cubical cells, several layers of polygonal and an upper layer of pavement epithelium. (b) The epithelium is epidermoids consists of a lower layer of cuboidal cells, followed