Reviews and Bibliography.

Annual of the Universal Medical Sciences. A Yearly Report of the Progress of the General Sanitary Sciences throughout the World. Edited by CHARLES E. SAJOUS, M. D., and Seventy Associate Editors, Assisted by over Two Hundred Corresponding Editors, Collaborators, and Correspondents. Illustrated with Chromolithographs, Engravings, and Maps. The F. A. Davis Co. publishers, Philadelphia, New York, Chicago. London, F. J. Rebman. Australian Agency, Melbourne, Victoria. 1894.

Let us endeavor to form some approximate idea of the magnitude of this work. A total of eleven hundred and fifty-three journals have been consulted in gathering the reports. If each journal has on an average thirty pages, for the year we have about four hundred and five thousand pages. Then there have been read in the search for material one thousand and fourteen books, pamphlets, reports, etc. If these have averaged a hundred pages each we have here more than another hundred thousand pages. In short we have in these volumes the gist of half a million of pages of contemporary medical literature. One man performing this work and taking one day of rest each week, in addition to Sunday, would require eightythree years to complete it. Yet, thanks to the united industry, intelligence, and concert of nearly three hundred of the leading men of the profession, we can enjoy all that is valuable in this vast amount of literature by reading five volumes, making a total of twenty-five hundred pages, which can be done in a couple of months.

In the character of the work every year shows an improvement, and best of all the collaborators are learning to know the purveyors of falsehood and we see every year less from men whose statements their neighbors know are not entitled to credence. This, of course, nearly always relates to treatment. In matters of science the improvement has kept pace with the widening of the field from which the harvest is garnered. The promoters of this great and useful work can not be easily over-rewarded in either gratitude or financial returns.

D. T. S.

System of Surgery. Edited by FREDERIC S. DENNIS, M. D., LL. D., Professor of the Principles and Practice of Surgery, Bellevue Hospital Medical College, etc. Assisted by JOHN S. BILLINGS, M. D., LL. D., Edin. and Harvard, D. C. L., Oxon; Deputy Surgeon-General, U. S. A. Vol. I. The History of Surgery, Pathology, Bacteri ology, Infections, Anesthesia, Fractures and Dislocations, Operative Surgery. Profusely illustrated. SSO pp. Philadelphia: Lea Brothers & Co. 1895.

The first volume of this system consists of contributions from Dr. John S. Billings, Wm. T. Councilman, Wm. H. Welch, Charles B. Nancrede, Wm. H. Carmalt, J. Collins Warren, Phineas Sloane, Frederic S. Dennis, Hermann M. Biggs, Horatio C. Wood, Arpad G. Gerster, and Stephen Smith. Nearly all of

these men are not only surgeons by recognized authority, but are also already familiar to the medical world as authors of leading text-books, and they have been induced to contribute in order to present to the profession a complete review of the domain of modern surgery. The work seems to be an undertaking, though one not quite so full as Seale, to accomplish in surgery what "twentieth century medicine is to do for general medicine." And those to whom the task is allotted to take part in the surgery of the twentieth century having this work in hand with which to cross the bourne will have little need of other help, but will possess in this a treatise at once complete, comprehensive, and compact. The illustrations are unusually fine, and the letter press and binding all that could be desired.

D. T. S.

The Principles of Surgery and Surgical Pathology. General Rules Governing Operations and the Application of Dressings. By Dr. HERMAN TILLMANS, Professor in the University of Leipsic. Translated from the third German edition by JOHN ROGERS, M. D., New York, and BENJAMIN TILTON, M. D., New York. Edited by LEWIS A. STINSON, M. D., Professor of Surgery in the University of the City of New York, Medical Department. With four hundred and forty-one illustrations. 788 pp. New York: D. Appleton & Company. 1894.

This popular German surgery was selected by the translators and editor for the reason that it presents with exceptional economy an arrangement by which general principles are treated fully and in advance of their special application. The feature that impresses one most is that it is a book of work. Divisions are distinctly made and definitions are clear, but one feels in every line that every thing is pointedly directed to intelligent and skillful operation and treatment by the most advanced rules of science; that besides being well-grounded in the principles one must be devoted to details and familiar with every accessory. It is a good selection and a fine translation. However, if the editor had thought fit to leave off the great number of credits given to continental surgeons with unspeakable names, he would have done a great service to all American students who are unacquainted with the Polish, Hungarian, and Russian languages, which is not a small number.

D. T. S.

Obstetric Surgery. By EGBERT H. GRANDIN, M. D., Obstetric Surgeon to the New York Maternity Hospital, Gynecologist to the French Hospital, etc., and GEORGE W. GARMAN, M. D., Obstetric Surgeon to the New York Maternity Hospital, Gynecologist to the Cancer Hospital, etc. With eighty-five illustrations in the text and fifteen full-page photographic plates. Royal octavo. 220 pp. Extra cloth, $2.50. Philadelphia: The F. A. Davis Company, Publishers. 1894.

In this volume is described every necessary surgical operation to be met with in obstetric practice. The key-note is election, the authors believing that through resort to timely operation the results that are daily secured in general surgery are obtainable in obstetrics, if the same principle be held in view. The volume is written from a teaching basis and is not burdened with bibliography or statistics. Such a volume as this was needed, and the distinguished authors have well met the need.

D. T. S.

Abstracts and Selections.

TRACHEOTOMY IN EMERGENCIES.-The ordinary operation of tracheotomy is quite simple with a full set of appropriate instruments at hand, but often the necessity for the operation arises suddenly and when we are not prepared for it, and undoubtedly many a child with laryngeal diphtheria has gone to its grave because the physician feared to do the operation without the customary instruments and tubes.

In a recent case I was placed in such a position, with asphyxia approaching and no instruments at my command. I therefore offer the means I adopted with the hope that it may assist some fellow-practitioner in a similar strait:

A child, two years and a half old, came into my hands with diphtheria of three days' standing. The membrane could be seen across the lower half of the pharynx, and the larynx was so badly involved that the child could not speak, and the respiration was rapid and wheezing in character. With the assistance of Dr. P. J. F. Martenet I injected a bottle of No. I Behring's antitoxin. On the next morning the child was much improved, and the voice and breathing better. We injected another dose of antitoxin, and left considering the child almost out of danger. When I returned at 9 P. M., however, the condition was much worse, the respiration gasping, and the child's face becoming cyanotic, showing gradually increasing occlusion of the trachea or larynx.

Not being prepared for intubation or tracheotomy, and being in the country five miles from any instrument house, we had given up all hopes of the child's recovery, when, finding a small glass tube, the thought struck me that we might utilize it for a tube.

This tube was of about the size of a small lead pencil. Removing the chimney from a lamp and twirling the tube rapidly in the flame I was soon able to bend it into the proper curve for a tracheotomy tube. It was then cut off by making a nick in it with a file or dull knife and breaking over the ends of the thumbs. The rough ends were rounded by holding in the flame.

After injecting cocaine subcutaneously in the median line of the neck, I made an incision down to the trachea with a pocket scalpel which I happened to have.

I may say that, as I desired to avoid the isthmus of the thyreoid and go below it, the incision was made from the second tracheal ring downward for an inch and a half.

All hemorrhage having been stopped by hot compresses, a longitudinal incision three quarters of an inch long was then made into the trachea, and the child turned on its belly so that no blood would flow into the trachea.

Hemorrhage having ceased, the child was turned on its back and the bent glass tube inserted, and in a few minutes the breathing became more regular, the cyanosis disappeared, and the child went to sleep.

As it now was, the tube had to be held in place, so I determined to improvise another which could be fastened around the neck with tapes.

So, bending another tube as before, I wrapped it with thread to prevent breaking. A cross-piece was then made of wood half an inch wide and an inch long, a hole being cut in the middle to receive the glass tube. Holes were also cut in each end to receive the tapes. Having fastened the cross-piece to the tube by wrapping it with thread, this improvised tracheotomy tube was inserted into the trachea and secured in position by the tapes around the neck.

The child slept well all night, and by the next evening the antitoxin had got in its work, and the larynx was so cleared of membrane that the tube was removed entirely. In a few days recovery was complete.

As tracheotomy wounds are always infected, it is the custom to allow them to heal by granulation and not to bring the edges together by sutures.

In this case, having been able to stop the suppuration by vigorous antiseptic treatment, I decided to risk it, and drew the edges of the broad, gaping wound together with sutures. The result was very satisfactory; no stitch abscess or any suppuration followed, and in place of a broad ugly scar a small linear one resulted.

It would seem that many unsightly scars from infected wounds about the face and neck could be avoided by suturing as soon as suppuration had been cured. In this case the edges were well cauterized by nitrate of silver before being drawn together.-Dr. Hugh H. Young in the New York Medical Journal.

"POST-INFLUENZAL MENINGITIS."-The subject is one which has been. much discussed and reported upon of late by medical authorities both in Paris and Berlin; but it is not a new point in post-influenzal affections, at any rate at Lyons, where it has been studied and described since 1889. In meningitis following influenza, which is rarely fatal, death hardly ever resulting from the influenzal affection itself, there is no lesion whatever to be found at the necropsy either in the brain or medulla. The affection is carried by the special action of the toxines secreted by the influenzal microbes producing inhibition phenomena, toxines which appear to have a very special predilection for the nerve centers.

Sometimes, though the event is rare, in cases of patients dying from meningitis which has supervened on influenza, suppurating lesions of the brain and meninges are found, but these cases are not instances of postinfluenzal meningitis strictly so-called; it is rather a secondary affection brought out by influenza-a true meningitis preceded by influenza, and due to a streptococcus, staphylococcus, Eberth's bacillus, or more often to the pneumonococcus. But these cases of suppurative meningitis succeeding

influenza are very rare, for out of the records of thousands of cases collated by Dr. Roque from various sources there are only eleven deaths due to this sequel to "la grippe." Other cases belong to the category of post-influenzal meningitis strictly so-called, which have a gravity of their own, symptoms quite similar to those of true meningitis, but none the less essentially very benign in nature, the brain not being injured by the progress of the malady itself. (It might have been damaged previously.) Dr. Roque was induced to again put forth his views by the occurrence of a case under his care which unfortunately proved fatal, and in which a necropsy was made. "This patient was admitted into the Hôtel Dieu a short time ago for influenza, having no special features and running a mild course, so that only the routine treatment was prescribed and no exceptional notice was taken of the case. But one day the patient was attacked with intermittent delirium, shortly afterward becoming almost continuous, which together with other special symptoms attracted particular attention. Careful examination showed paralysis of the external recti muscles of the eyeballs, and very acute pains in the head, especially in the frontal region. Then the palsy involved the other recti. The patient had vomiting of cerebral origin, rigidity, retraction of the head, tenderness over the nuchal muscles, violent excitement requiring restraint at times, and, in a word, all the phenomena of meningitis; but it was remarkable that in spite of all this there was no marked rise of temperature, which ranged from 38° to 39° C. Suitable treatment was adopted and a favorable issue was foreseen, the condition, indeed, beginning to improve, when the patient's temperature suddenly rose and death ensued. One hardly knew what to think of this anomalous fact, and the necropsy was carefully made. Now, although this patient had presented all the symptoms of meningitis, there was absolutely no lesion found in the brain, no special change of any kind, although several sections were made. Yet if, as stated above, post-influenzal meningitis be a very benign affection, why did this patient die, especially in this anomalous manner? The explanation is simple; it was because he had been attacked with a secondary cardiac affection, for the right auricle was found to be filled with a firm coagulum sending prolongations into the vessels and ventricle."

To sum up, post-influenzal meningitis is a benign affection which advances with violence, but which has not actually ever any serious issue. The meninges are not in the least injured, and the affection is brought about by the special action on the meninges of the toxines secreted by the influenzal microbes, and not by the microbes themselves; toxines for which the cerebro-spinal fluid probably serves as a receptacle, just as this fluid is one of the best culture media for microbes in local disease. This wholly peculiar action of the toxines of the influenzal microbes is confirmed by the fact that the subjects of influenza who do not have post-influenzal meningitis do not escape presenting very marked symptoms of prostration, hypochondriasis, and depression (lasting a month or so), phenomena which may be regarded as highly attenuated forms of the action on the nerve centers produced by the toxines.-Dr. T. C. Naxime in the London Lancet.