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wards preparatory to dividing it. I well know that I have made such an error more than once when the utmost care was taken by me, and I have not succeeded in thoroughly dividing the stricture without several efforts at repetition being required before ultimate success was attained. With my urethratome I follow this course: The urethra is first anæsthetized with a few drops of cocaine, four per cent. solution, when the bulb is introduced into the penis until the triangular ligament five inches inwards from the meatus retards its further progress. The closed bulb will pass without interference unless perchance a stricture of too small an opening, interfering with its easy course, is encountered. This need not at any time prevent the passage of the bulb through the stricture sufficient to allow it to reach the triangular ligament further on along the course. When the whole anterior urethra has been traversed, the operator will hold the handle of the instrument in his right hand and with the other steady the canula which extends from the handle to the closed bulb. The surgeon now slides the canula backwards towards the handle, the effect of which is to spread the bulb into two parts, which press and distend the urethra upon either side. The instrument in this condition is slowly and steadily withdrawn outwards from the point where the bulb was caused to divide. The presence of any stricture, however slight, will at once be recognized as the divided bulb attempts to pass it. The surgeon will at this time draw out and drive backwards rapidly the knife which lies encased and hidden at a point where the divided bulb unites when closed, and which is regulated by a thumbscrew at the handle of the instrument. The canula is now pushed forwards in the direction of the bulb, and the instrument is again closed and ready for removal. The accompanying diagram will by its illustration convey a more definite idea of the mechanism of the bulbous urethratome after being opened as it lies in the urethra at the moment when the stricture is about to be divided.


A represents the case in which the knife or blade lies hidden, while E is the thumbscrew with which it is manipulated at the moment when it is desired to divide the stricture. B represents the bulb divided, with the canula drawn backwards towards the handle, while a reverse motion of the canula closes the semi-bulb again and hides the knife case also. F is the button and screw with which the canula is manipulated while being slid backwards or forwards, the screw attachment at this point permitting the canula to slide back just so far as to regulate the amount of distention produced in the urethra when the bulb is opened. The canula is so graduated that the surgeon may locate the presence of a stricture and at the same time learn the exact distance of its site from the meatus uremanus. This is often desirable when simply a diagnosis of stricture is sought

without the desire to divide it at the same time. Fred Haslam & Co., instrument makers, Brooklyn, have in charge the manufacture of the bulbous urethratome. The instrument has been made with a view to the necessity of strict antisepsis, and can easily be taken apart by the surgeon for the purpose of thorough cleansing after



Book Reviews.

Twentieth Century Practice. An International Encyclopedia of Modern Medical Science.

By leading authorities of Europe and America. Edited by Thomas L. Stedman, M.D.

In twenty volumes. Vol. XIII. Infectious Diseases. William Wood & Co., New York, 1898. Pp. 621. This volume, issued with the promptitude characteristic of the publishers, treats of especially important subjects. The book opens with a monograph on Ptomains, Toxins and Leucomains,” by Victor C. Vaughan, M.D., Ph.D. This is followed by an article on “Infection and Immunity" by Harold C. Ernst, M.D., Boston. Then come in order “Water-Borne Diseases” by Ernest Hart, D.C.L., London, and Solomon C. Smith, M.D., M.R.C.P., London; "The Duration of the Periods of Incubation and Infectiousness in acute Specific Diseases,” by Dawson Williams, M.D., F.R.C.P., London; "Smallpox," by John William Moore, M.D., M.Ch., Dublin; “Vaccina," by P. Brouardel, M.D., Paris and “Mumps" by Jules Comby,

The volume is distinguished by the same wise discrimination in the selection of topics and authors and for the same thoroughness of treatment that have marked preceding volumes of

M.D., Paris.

the series,

lustrated. Pp. 1077

The American Year Book of Medicine and Surgery Collected and arranged by

W. B. Saunders, 925 Walnut St., Philadelphia, 1898. $6.50. The object of the “Year-Book” is to give in compact form, annually, an epitome of new and progressive medical truths of the year, as reported in medical literature at large; this information being collected and arranged by eminent American specialists and teach ers under the direction of a general editor. Each associate editor, who is a distinguished practitioner or teacher, critically reviews the material collated, and comments upon the value of new treatments and theories. Special training and experience are obviously essential for the accurate choice of those things in the line of true progress, and not only to select and summarize, but also to pronounce decisions upon the merit of a discovery or the value of a treatment. These discussions are carefully arranged and elaborately indexed.

Illustrations are liberally introduced; the engravings—many being in colors are taken from photographs or are reproductions of the authors' cuts appearing with the respective original contributions to the journals quoted. A vast accumulation of learning and a wealth of suggestion have been compressed into the briefest possible complete reports and criticisms. The collecting of widespread facts and arranging and amalgamating them into a single volume is a magnificent achievement of the editorial staff. This monumental publication presents in its pages the progress of the medical world in every branch.

A Text-Book of the Diseases of Women. By Henry J. Garrigues, A.M., M.D.

Second Edition, thoroughly revised. W. B. Saunders, 925 Walnut St., Philadelphia, 1897. $4.00. Pp. 728.

The first edition of this work met with a most appreciative reception by the medical press and profession both in this country and abroad, and was adopted as a text-book or recommended as a book of reference by nearly one hundred colleges in the United States and Canada. The author has availed himself of the opportunity afforded by this revision to embody the latest approved advances in the treatment employed in this important branch of medicine. He has also more extensively expressed his own opinion on the comparative value of the different methods of treatment employed. The book contains three hundred and thirty-five engravings and color plates. It is to be heartily commended.

A Practical Treatise on Sexual Disorders of the Male and Female. By Robert

W. Taylor, M.D., Clinical Professor of Venereal Diseases in the College of Physicians and Surgeons, New York. With 73 illustrations and 8 plates in color and monochrome. Cloth, $3.00, net. Lea Brothers & Co., New York and Philadelphia. Pp. 448.

In the volume at hand is presented the personal experience of the author, whose widespread authority as a genito-urinary and venereal specialist has brought him an extensive practice among those suffering from disorder of the sexual functions. The prevalent lack of accurate knowledge as to the pathology and etiology of disease of this nature led him to undertake exhaustive investigation in ines not hitherto pursued, with the result of exposing much that is false in accepted beliefs, and in many instances indicating new methods of relief. Symptoms ar, made secondary to the various conditions which give rise to them, and the consideration of these conditions places it within the power of the practitioner to rationally treat an entity and not pursue the shadow.

In the construction of his volume, the author has followed the same practical lines which have made his "Pathology and Treatment of Venereal Diseases” a most helpful assistant of the practitioner, and which will secure for this work an equal measure of approval from everyone having to deal with sexual disorders.

Diseases of the Eye. By Edward Nettleship, F.R.C.S. Revised and edited

by W. T. Holmes' Spicer, M.A., F.R.C.S. Fifth American from the Sixth English Edition. 2 colored plates and 161 engravings. Lea Brothers & Co., New York and Philadelphia, 1897. $2.25. Pp. 521.

This book fills a peculiar place in the rich literature of ophthalmology, as it compendiously answers the needs of practitioners as well as students. Its wide use is furthermore reflected in a remarkably moderate price. The favor which it has thus found among all English-speaking nations has led to still another advantage, namely, frequent revision and consequent fidelity to the rapid progress of ophthalmology. The present edition has had the benefit of thorough revision by one of the leading English ophthalmologists, and also by equally eminent American authority. In certain points the views and practice of American ophthalmologists differ somewhat from those prevailing in Great Britain, and accordingly additions will be found in the text wherever necessary to render it a true exposition of American practice. The section on the Detection of Color-Blindness with which Professor Thomson enriched recent American editions has been revised by him, rendering the work indispensable to railroad surgeons. Health of Body and Mind. Some Practical Suggestions of How to Improve

Both by Physical and Mental Culture. By T. M. Topham, M.D., 1897
Pp. 296.

The author of this work is evidently deeply impressed with his subject and is thoroughly in earnest. In his preface he says: “Nowhere in life do we see so much ignorance displayed as in the conduct of the average man's habitual methods of treating himself. He goes on from day to day displaying a carelessness which would shock a more sensitive individual and cause him to blush with pain if he could see himself as others see him.” The work gives full and detailed directions for physical and mental training and will be of good value to those who intelligently use it. Principles of Medicine. By Charles S. Mack, M.D. The W. T. Keener Co.,

96 Washington St., Chicago, 111., 1897. $1.00. Pp.133. The object of this book, in the words of its author, “is to show just what is the cure sought in any given practice

of Homeopathy--to show that that cure cannot be intelligently attempted excepting under guidance of similia similibus curantur as law and to show that one may consistently accept Homceopathy and at the same time accept whatever else is good in medicine." The book is written for college students, but will prove both interesting and instructive to the


Diseases of Females and Children and Their Homeopathic Treatment. By Wal

ter Williamson, M.D. Fourth Edition. Boericke & Tafel, 1897. $1.00,

This is a work evidentally designed for the laity. The treatment advocated is in the main good and the adjuvants proposed will do no

Pp. 256.



W. B. Saunders, 925 Walnut St., Philadelphia, Pa., announces a long and very valuable list of new books for early publication. The energy of this firm keeps it always in the front rank and its publications are standard in the medical profession. For the information of our readers we give the list mentioned. An American Text-Book of Diseases of the Eye, Ear, Nose and Throat. Edited

by G. E. de Schweinitz, M.D., Professor of Ophthalmology in the Jefferson Medical College, Philadelphia; and B. Alexander Randall, M.D., Professor of Diseases of the Ear in the University of Pennsylvania and in the

Philadelphia Polyclinic. An American Text-Book of Pathology. Edited by John Guiteras, M.D., Pro

fessor of General Pathology and of Morbid Anatomy in the University of Pennsylvania; and David Riesman, M.D., Demonstrator of Pathological

Histology in the University of Pennsylvania. An American Text-Book of Legal Medicine and Toxicology. Edited by Fred

erick Peterson, M.D., Clinical Professor of Mental Diseases in the Woman's Medical College, New York; Chief of Clinic, Nervous Department, College of Physicians and Surgeons, New York; and Walter S. Haines, M.D., Professor of Chemistry, Pharmacy and Toxicology in Rush Medical College,

Chicago, Illinois. Stengel's Pathology. A Manual of Pathology. By Alfred Stengel, M.D.,

Physician to the Philadelphia Hospital; Professor of Clinical Medicine in the Woman's Medical College; Physician to the Children's Hospital; late

Pathologist to the German Hospital, Philadelphia, etc. Church and Peterson's Nervous and Mental Diseases. Nervous and Mental Dis

eases. By Archibald Church, M.D., Professor of Mental Diseases and Medical Jurisprudence in the Northwestern University Medical School, Chicago; and Frederick Peterson, M.D., Clinical Professor of Mental Diseases in the Woman's Medical College, New York; Chief of Clinic,

Nervous Department, College of Physicians and Surgeons, New York. Heisler's Embryology. A Text-Book of Embryology. By John C. Heisler,

M.D., Professor of Anatomy in the Medico-Chirurgical College, Philadel

phia. Kyle on the Nose and Throat. Diseases of the Nose and Throat. By D.

Braden Kyle, M. D., Chief Laryngologist to St. Agnes' Hospital; Bacteriologist to the Orthopedic Hospital and Infirmary for Nervous Diseases; Instructor in Clinical Microscopv and Assistant Demonstrator of Pathol

ogy. Jefferson Medical College, Philadelphia. Hirst's Obstetrics. A Text-book of Obstetrics. By Barton Cooke Hirst, M. D.,

Professor of Obstetrics in the University of Pennsylvania. West's Nursing. An American Text-Book of Nursing. By American Teach

Edited by Roberta M. West, Late Superintendent of Nurses in the Hospital of the University of Pennsylvania.

In addition to the above list Mr. Saunders also announces the publication of an English edition of the world-famous Lehmann "Medicinische Handallanten.” For scientific accuracy, pictorial beauty, compactness and cheapness, these books surpass any similar volumes ever published. Each volume contains from 50 to 100 colored plates.


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