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Wounds of the Air-passages.-Of twenty-five cases of suicidal wounds of the throat that came under the care of Platt (Brit. Med. Journ.; Amer. Journ. Med. Sci.) ten involved injuries of the air-passages. The method of treatment to be employed he summarizes as follows:

1. Suicidal wounds of the throat should be treated by primary suture in all cases where the general condition of the patient permits.

2. Antiseptic precautions are most important. 3. If necessary, chloroform should be administered and is perfectly safe.

4. Divided muscles should be sutured, and in bringing together the edges of skin, the inversion caused by the platysma muscle should be corrected.

5. The wound in the air-passage should be completely closed.

6. In many cases it is quite safe to dispense with the use of a tracheotomy tube. If a tube is deemed necessary, it should not be introduced through the suicidal wound in the airpassage, but through a fresh vertical cut at a lower level.

7. Silk is the best material for suturing the larynx or trachea.

8. During the after treatment it is unnecessary, except in certain special cases, to feed by a tube or by the rectum.

9. If the above methods of treatment be adopted, not only will a very large proportion of even dangerous and extensive wounds of the air passages recover, but the period of recovery will be greatly shortened. The patient will not be exposed to the same risks of secondary inflammatory complications, and will be much less liable to the occurrence of permanent stenosis of the trachea or the formation of aerial fistulæ.

Indications for Hysterectomy.-John Homans (Am Journ. Med. Sci.) presents the following indications for hysterectomy:

1. Intractable, often recurring hemorrhage without discovered fibroid or malignant disease, when all the usual remedies have been tried, and curetting has been done every few weeks without permanent success. Clinical reasons prevail over histological and practical over theoretical.

2. In all kinds of malignant disease, when the operation is possible without permanent injury to the bladder or bowels, even if there is little hope of permanent cure. The hemorrhage may be stopped, and there is less subsequent pain and discomfort than when the disease is left to run its natural course.

3. (a) In a case of fibroid tumor which causes much discomfort or (b) threatens death by hemorrhage (and it sometimes not only threatens, but causes it as suddenly as does a pulmonary hemorrhage). (c) Because it may increase and become too burdensome to allow life to be worth living. (d) Because it may develop a cancerous character. (e) Because by pressure on the abdominal organs it may destroy life. (f) Because it may become cystic and thoroughly adherent. The author does not. mean fibroids with dilated lymph spaces, but fibroids with cysts as clear and distinct as those of ovarian tumors. (g) Because it may be an ever-present anxiety. (h) Because it may cause edema of one or both extremities and phlebitis to be followed, perhaps, by the passage of an embolus into the circulation, causing death by cardiac, renal, pulmonary or hepatic disease. (i) Because it may become twisted with the uterus as a pedicle, and must be removed immediately to save life. (j) Because a very sensitive single woman, in good health and active, demands its removal on account of the disfigurement it causes. (k) Because the operation to-day in experienced hands is almost uniformly successful.

4. In cases of uncontrollable complete prolapse, particularly after the menopause, when pessaries and all the usua! operations for holding up the uterus have been tried and found useless.

5. In case of incurable chronic inversion.

6. In case of infection, when the removal of the Fallopian tubes affected with salpingitis has not cured the patient.

7. To cure puerperal sepsis where the diag nosis is as certain as it can be.

Elastic Tissue in the Fallopian Tubes.-Buchstab (Centralb. f. Gynaek.; Amer. Journ. Med. Sci.) from a careful study of one hundred and two specimens of normal and diseased tubes removed from children and women, arrives at the following conclusions: (1) Until the end of the first year elastic tissue is found only in the peritoneal and subserous coats of the tube around the vessels. (2) Between the ages of three and seven this tissue becomes thicker, especially in the neighborhood of the vessels, and fibers are seen in the muscular layers. A few delicate fibers appear in the submucosa. (3) In the tubes of girls between twelve and thirteen years of age this tissue is well developed, the vessels being surrounded by a dense network. The muscularis mucosa contains a

small quantity, but it is absent from the mucosa. (4) Between fourteen and fifteen there is a great increase in the amount of elastic tissue throughout the different layers, and for the first time delicate fibers are

observed in the mucosa. (5) In women between twenty-one and forty-five this tissue reaches its full development, while after the climacteric it begins to atrophy, reaching its minimum at the age of fifty-five years. (6) In the senile tube, elastic tissue is found only in the serosa and superficial muscular layer. (7) There is a notable increase in hydro-and pyosalpinx, so that in some specimens it formed actual layers, while in tubal gestation it is absent or slightly developed at the site of the sac, whether the latter has ruptured or not.

Retinal Hemorrhage. In a paper on retinal hemorrhage after middle age, and its bearing on the duration of life, read before the Massachusetts Medical Society, Dr. Hasket Derby of Boston (Amer. Journ. Med. Sci.) finds that this symptom is one of great importance, and the prognosis serious. The detection of the disease is easy for one who has a moderate acquaintance with the examination of the interior of the eye. The cases themselves are far from infrequent, and the warning given by their occurrence may be practically utilized for the regulation of important business interests. Life itself may often be prolonged by abstinence from exhausting labor, by appropriate relaxation, and by following a suitable regimen.

Of about ninety cases of the kind he had seen, Derby succeeded in tracing the subsequent course of events in thirty-one cases between the ages of forty-three and eighty. three. Twenty-five of these died after brief illnesses, some, indeed, with the utmost suddenness. Eleven of this number died of heart disease, fourteen of apoplexy. Five were at last accounts living, their average age when first seen being fifty-four, and their cases followed up on an average of thirteen years. One patient, a man of eighty-three, died of an affection of the bladder six years after he came for retinal hemorrhage.

Intestinal Antisepsis. - Dr. Heinrich Stein (Centralb. f. d. Gesam. Therap.; Dom Med. Month.) enumerates the following intestinal antiseptics: Calcium carbonate (two and onehalf drams per day in one grain doses), or magnesia (ninety grains per day) in abnormal acidity, Creosote, guaiacol and resorcin are of

service, but their action is shorter, though they may act on distant areas. Menthol (one and one half grains twice or thrice daily), naphthalin (one and one-half to seven grains at a dose, or seventy-five grains per day), thymol (one and one-half grains several times daily in alcoholic solution); since absorption limits the action of the drug in the intestine, various antiseptics have been prescribed with insoluble substances: salol, parachlorsalol, kresosalol, beta-naphtholsalol, or betol. These are broken up in the intestinal tract by the action of the pancreatic secretion and by unformed intestinal ferments into salicylic acid, kresol, etc. The absolutely insoluble antimicrobic remedies can be given in much larger doses. These include phenolbismuth (fifteen to forty-five grains per day), the same dose for kresol, bismuth, zinc salicylate, trioxy-methylen. For irrigation, solutions of salicylic acid in sterilized water (one to two parts per thousand); silver nitrate (one-tenth to five-tenths per thousand); boric acid (fivetenths per cent); creolin (one to two per cent); tannin (two to five per cent) may be employed. Applications of insoluble antiseptic powder, as afforded by bismuth preparations, may be used during irrigation.

When Shall We Use the Forceps?-Dr. Park (Am Gyn. and Obstet. Journ.) lays down the following principles: (1) Indications for the use of forceps rarely arise in the first stage of labor before the membranes have been ruptured. (2) It may be necessary to employ the forceps during the first stage, when the waters have escaped on account of the increasing exhaustion of mother and child. (3) It is proper during the first stage of labor to apply the forceps for accidents, whenever they may arise, notably in certain cases of convulsions, placenta previa and prolapse of the cord. (4) In the second stage it is proper to apply the forceps half an hour after the head ceases to advance, when there is no disproportion between the passage and the passenger. (5) When, however, there is a tight fit between the child and the birth canal, the use of the forceps may be delayed. This delay should rarely exceed two hours after the head ceases to advance. (6) If the head is engaged, and neither advances with the pain nor recedes after the pain, the forceps should be promptly applied.

Bacteriological Examination of Blood.-In the American Journal of Medical Science a summary is given of the results obtained by Dr. John Shade Ely in the bacteriological examina.

tion of the blood. The investigations have been of value in throwing light upon the occurrence of complications in diseases ordinarily localized. But little has been gained in diagnosis.

The pneumococcus has been found in the blood in pneumonia and infective endocarditis; pyogenic germs in pyemia, erysipelas, puerperal fever, osteomyelitis and in infective endocarditis; the bacillus coli communis in cystitis with pyemic infection; the gonococcus in infective endocarditis in gonorrhea; the tubercle bacillus in tuberculosis, and the typhoid bacillus in typhoid fever.

Furunculosis.-Robin recommends the following treatment for boils (Journal des Praticiens; Therap. Gaz.):

The skin is first washed with water and pure soap, and afterwards the following prescription made up into three cachets is administered: R Sublimed sulphur. ....drams 21⁄2

Powdered camphor.. ...grains 30

As soon as a point of redness appears in the skin a small compress is applied over it, which will often abort the boil. If the boil has already actually formed, the complete evacuation of its contents is needed, and after it is opened the following should be applied to it: B Sublimed sulphur. ......drams 21⁄2

Powdered camphor.. ...drams 21⁄2 Glycerin ...enough to make a paste. After this has been applied for twenty-four hours the part should be washed with boric acid water and atomized with a one per cent solution of carbolic acid, and then the application of the sulphur paste should be repeated.

The New Tuberculin.-Koch's new tuberculin is discussed by Schultze (Deut. med. Woch.; Am. Journ. Med. Sci.). He reports nine cases, treated for periods varying from one to two months. In his experience the new tuberculin is free from the ill effects of the original prepa ration. Four of his cases remained unimproved, two improved, one developed a tubercular ulcer of the larynx, one possible tubercular enteritis; in one case a pleurisy improved. In so short a time it is impossible to say just what was the effect of tuberculin. From B. Fraenkel's clinic Bussimus reports nineteen cases treated with the T. R. tuberculin, with fifteen recoveries. Three cases of lupus seemed much improved.

Subcutaneous Treatment of Abscesses. -Dr. Lanphear says (Med. Herald; Cincinnati Lanc. Clin.) that abscesses frequently form at a point where the scar following free incision is very

objectionable. With chronic or "cold" abscesses the method of aspirating and injecting an antiseptic solution has not been practiced long. Recently Dr. Riechaud of Bordeaux has adopted this procedure with success in acute abscess, instead of the time-honored free incision of the most dependent part. The abscess is aspirated, after which a solution of carbolic acid, 1 to 20, or of 10 per cent iodoform emulsion is injected. This method has been practiced for several months with marked success.

Tic Doloroux.-Ewart recognizes the following indications of gout as etiological factors in tic doloroux (Brit. Med. Journ.; Alienist and Neurologist): (1) It often occurs in the healthy with ruddy complexion, which is common in sthenic gout. (2) Presence of Heberden's nodules or of tophi in the ears. (3) History of gravel or stone. (4) Nervous, gastric, intestinal and hepatic disturbances of long duration. (5) Strength of pulse and endurance of patient after prolonged pain and insomnia. (6) Adverse influence of alcohol and certain diet. (7) Presence of uric acid in the urine. The nature of gout as an etiological factor is not explained further than that it probably is an irritant to the nervous system.

Intestinal Paralysis After Abdominal Operations.--According to Engstroem (Zeits. fuer Geb. und Gynaek.; Am. Journ. Med. Sci.) intestinal paralysis is usually due to sepsis when following surgical operations in the abdomen, but may also be due to mechanical and chemical irritation. He mentions as a possible cause the excessive use of saline purgatives prior to operation.

Chloride of Calcium in Hemophilia.-Dr. A. E. Ebright (Lancet) has used with brilliant effect chloride of calcium in the treatment of hemophilia and other diseases tending to frequent hemorrhages. The treatment is based on experiments which proved that calcium chloride increased the power of coagulation of the blood. This treatment deserves more general consideration.

Typhoid Fever in Maidstone.-In an editorial in the Lancet we are informed that the number of typhoid fever cases recorded in the present epidemic at Maidstone has reached 1,748 by October 27. The only parallel in the history of England was the epidemic in Worthing, in which 1,411 cases occurred between May and November, 1893. Both of these epidemics originated from a defective water supply.

New Publications.

Byron Robinson's The Peritoneum -The Peritoneum by Byron Robinson, B. S., M. D., Author of "Practical Intestinal Surgery," etc. Part I, Histology and Physiology. Cloth, 406 pages, with 247 Illustrations; Bibliography of the Peritoneum, 103 Pages, $3.75 net. Chicago: C. V. Waite & Co., 70 State street, 1897.

The first part of Byron Robinson's long-promised book on the peritoneum, which has been so long looked for, has at last appeared. The indefatigability of the author and his capacity for hard study and arduous investigation are well known, but the published results of his work show a marvelous wealth of research and study. The work is a pioneer in its own line of study. It is eminently original, and yet due credit has been given to the authorities consulted. It represents the results of half a dozen years of personal labor and of more than two hundred experiments, and includes, well selected and carefully arranged, all that is known of the peritoneum up to date.

This volume is devoted to the histology and physiology of the peritoneum, prefaced by a his torical sketch. The subjects taken up are the endothelia of the free peritoneal surface, the subperitoneal tissue, the blood-vessels, lymphatics and nerves of the peritoneum; a short chapter devoted to the technique of the preparation of specimens of the peritoneum for microscopical' examination, and a resume of the physiology of the peritoneum. The classification of the subject is simple and comprehensive. It is treated with that completeness and originality which can come only from vast labor and persistent industry.

The book is not so limited in its applicability or usefulness as might be at first supposed. It is valuable to the abdominal surgeon, general surgeon and general practitioner alike, as it demonstrates the real value of peritoneal irrigation by noting the quantity of fluid the peritoneum can absorb, and how the absorption takes place. The author demonstrates that the peritoneum is a great lymph sac.

A feature of the book which enhances its value as a work of reference is the bibliography, which is the most extensive and complete of any thus far published. One hundred and forty-five of the two hundred and forty-seven illustrations are from the author's own drawing.

The book is well printed on good paper and neatly bound, and will stand as a monument to the industry of its author.

Lloyd's Right Side of the Car.-The Right Side of the Car. By Prof. John Uri Lloyd. Fourth Edition. Cloth, 68 pages, $1.00. Boston: Richard G. Badger & Co. 1897.

This, the latest book from the pen of John Uri Lloyd, the author of Etidorpha, is now upon the book market. This exquisite little booklet is all that it

was promised to be by the author and publisher. It is a charming little sketch in a charming garb, fit for a gift for a king. In this, "The Right Side of the Car," the gifted author, who, in his Etidorpha, showed such a wealth of sympathy of heart and true poetry, again touches the heart-strings and leads the reader to higher planes of thought. He pays a tender tribute to pure, lovely womanhood, while at the same time drawing a picture of America's grandest mountain, the beautiful snowpeaked Tacoma-'the Mother of Mountains." The story tells of a lovely girl, sunny herself as the sunlight she so loved, a young life nearly extinguished by the remorseless hand of consumption"one leaning over the verge of eternity and looking into heaven"—who had been placed in charge of the narrator, the only layman of a party of medical excursionists on their way to Tacoma, the home of the young woman. With longing eyes she steadfastly looks for the first glimpse of her beloved Tacoma, even as her mental gaze was riveted on the "Tacoma" beyond, her eternal home..

The proceeds of the sale of this book will be applied to a fund for a monument to be erected in memory of the late Dr. John King, and it is sincerely to be hoped that the response will be a liberal

one.

Kelley's About Children.-About Children: Six Lectures Given to the Nurses in the Training School of the Cleveland General Hospital, in February, 1896. By Samuel W. Kelley, M. D., Professor of Diseases of Children in the Cleveland College of Physicians and Surgeons, etc., etc. Cloth, 179 pages, $1.25 net. Cleveland: The Medical Gazette Publishing Company. 1897. Dr. Kelley does not claim that this book is a complete treatise on the diseases of children. He does, however, furnish a vast amount of practical information in small compass, which will be valuable to intelligent parents, nurses, students and practitioners. The author's style is clear, strong and condensed. He has a very happy way of impressing mportant facts indelibly upon his readers; he is always entertaining, often epigrammatic and never prolix or wearisome. Would that more authors would follow Dr. Kelley's example in this important regard.

Hall's Physiology.-A Laboratory Guide in Physiology. By Winfield S. Hall, Ph.D., M.D., Professor of Physiology Northwestern University Medical School, Chicago. With Appendices on Organization and Equipment. Two Colored Plates and Sixty Illustrations. Cloth, $2.50. Chicago: The W. T. Keener Co. 1897.

Dr. Hall has endeavored in this volume to supply a need by giving a brief manual of instruction in such physiological experiments as can be profitably So undertaken by a student in his medical course. far as independent experimentation is essential in

a medical education, such a work as this will certainly be of utility, and it ought to be received with favor.

The whole range of physiology is not covered, but if the course here laid down is followed the student will have a fair introduction to experimental physiological work. Its perusal by the average reading physician will also give him a better understanding of modern physiological research than he may have possessed, especially as to the methods and the forms and uses of apparatus.

Pozzi's Gynecology.-A Treatise on Gynecology. Medical and Surgical, by Dr. S. Pozzi, Associate Professor to the Faculty of Medicine of Paris, Surgeon to the Broca Hospital, etc. Third Revised Edition. Translated by Dr. Brooks H. Weils of New York. On volume, 950 pages, with over 600 Illustrations. Muslin, $5.50 net; leather, $6.50 net. New York: William Wood & Company. 1897.

The third edition of Prof. Pozzi's classical work needs little mention at the hands of the reviewer, as its place in medical literature is already so well assured. In addition to the author's well known skill as an operator and ability as a teacher, he possesses a rare faculty as a writer. His style is easy and graceful, his treatment of the topics under discussion complete, concise and yet comprehensive. The entire field of gynecology is covered most thoroughly, so that the work is now the standard and authority on the subject.

The book has been carefully revised by the author, many of the chapters have been rewritten and the subject matter brought up to date. The translaticn has been carefully and thoroughly made, and the printers, binders and publishers have done their work so weil that the book leaves nothing to be desired as to appearance or contents.

Illoway's Constipation in Adults and Children.— Constipation in Adults and Children, with Special Reference to Habitual Constipation and Its Most Successful Treatment by the Mechanical Methods. By H. Illoway, M. D., formerly professor of the diseases of children, Cincinnati College of Medicine and Surgery, etc., etc. Cloth, 495 pages, $4.00. New York: The Macmillan Company. 1897.

Just why the author should have specified in his title "constipation in adults and children" the reviewer does not understand, for it would seem that the entire human race is included in these two classes, nor does the author assist us by a prefatory explanation.

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every three days. He is at least conservative in his definition. He takes up the matter systematically, beginning with the anatomy of the intestine, flatus, physiology of defecation and description of feces. He then defines constipation, considers its etiology and classifies it minutely. Both the acute and chronic forms are subdivided into groups, and in most cases explanatory case histories are given.

He next discusses the symptomatology, diagnosis and results cf constipation, and then considers the most important part of the subject, namely, treatment. In order of value he describes massage, hydrotherapy, electricity, and medicine. The latter he considers as a means to be employed only after mechanical methods have been tried in vain, or as an adjuvant to mechanical treatment.

The work is characterized by simplicity, force and completeness of detail. It contains a vast amount of information on this important subject which has not, as far as we know, heretofore been assembled.

Report of Department of Health.-Biennial Report of the Department of Health of the City of Chicago. Being for the Years 1895 and 1896. 321, 32 and 51 pages. Chicago. 1897.

The

By reason of failure to appropriate money for the publication of a report of the health department for 1895, it became necessary to combine the reports for 1895 and 1896 in one volume. first part of the volume is devoted to the reports of divisions and bureaus; the second to vital statistics, and the third to statistics of mortality. To this is added a chronological summary of the mortality in Chicago for the last forty-five years. The reports which make up the book bear out the opinion so often expressed by us, that the department is doing thorough, excellent work, and that it is prevented from doing better work only by lack of means. The results as regards diphtheria, the inspection of milk, purification of vaccine virus, regulation of midwives, etc.. reflect great credit upon the department and its efficient heads, Dr. Arthur R. Reynolds and Frank W. Reilly.

Ringer's Therapeutics. - A Handbook of Therapeutics. By Sydney Ringer, M.D., F.R.S., Holme Professor of Clinical Medicine University College, etc., and Harrington Salisbury, M.D., F.R.C. P., Physician to the Royal Free Hospital, etc. Thirteenth Edition. Cloth, 746 pages, $4.00 net. New York: William Wood & Co.

1897.

When a work has gone through twelve editions little remains to be said by the reviewer. The present edition has been carefully revised, a chapter added on serum therapeutics and a short section on the use of the digestive ferments added to the invalid dietary. The work is continued on the same lines as previous editions, the chief idea being to make clinical considerations indicate or contraindicate the employment of medicines. The book is pre-eminently a handbook of clinical therapeutics.

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