many cases were infected from hospitals as from the operator. He reported a case where a patient was operated upon for a small ovarian cyst in which ether was used, and the patient died from the effect of the anesthetic. Necropsy could show no other cause for death.

Under the order of business, Drs. J. F. Graham and E. C. Blackburn were elected to membership.

BOOK REVIEWS.

THE PRACTICAL MEDICINE SERIES OF YEAR BOOKS. Comprising ten volumes on the year's progress in Medicine and Surgery. Issued monthly, under the general editorial charge of Gustavus P. Head, M.D., Professor of Laryngology and Rhinology, Chicago Post Graduate Medical School. Volume 1, General Medicine, Edited by Frank Billings, M S., M.D., Head of Medical Department and Dean of the Faculty of Rush Medical College, Chicago, with the Collaboration of S. C. Stanton, M.D. Price, $1.50. October, 1901. Chicago: The Year Book Publishers, 40 Dearborn Street.

The Year Book Publishers have undertaken to publish a practical medicine series of year books, which will comprise ten volumes and be issued monthly. It is the purpose of this series to cover in a concise yet sufficiently full manner the entire year's progress in medicine and surgery.

Volume one of this series, which considers general medicine, is edited by Dr. Frank Billings, with the collaboration of Dr. S. C. Stanton. The work is well arranged and seems to fully cover its field. The merits of The Year Book on the Diseases of the Nose, Throat and Ear, as published by these publishers, would go to indicate that they will achieve considerable success with the present venture.

A MANUAL OF PERSONAL HYGIENE. Edited by Walter Pyle, A.M.,M.D., Philadelphia. Illustrated. Price, $1.50 net. Saunders & Co., Philadelphia

and London. 1901.

In this splendid work the editor who has written on the subject "Hygiene of the Eye," has been assisted by the following contributors: "Hygiene of the Digestive Apparatus," Charles G. Stockton, M.D.; The Skin and its Appendages," George Howard Fox, M.D.; "The Vocal and Respiratory Apparatus," E. Fletcher Ingalls, M.D.: "The Ear," B. Alexander Randall, M.D.; "Physical Exercise," G. N. Stewart, M.D., and "The Brain and Nervous System," J. W. Courtney, M.D. To present this subject in a manner which shall appeal to the educated layman without pandering to popular prejudice or fads, is by no means an easy matter. To offer neither too much nor too little and to make all clear and distinct involves careful discrimination. To say that all of the contributors

have attained this is the truth.

In Dr. Stockton's section, the mechanism of digestion and absorption is ably described. There is a description of the teeth, with directions for the preservation of them, and the deformities of the jaws. There are also some valuable things said upon the diet. Dr. G. H. Fox, in dealing with the skin, extols the cold bath as a stimulant and tonic. He discusses the relation of the clothing to the skin and the deformities resulting from improper shoes. The care of the hair

and scalp is extensively described, and the massage of the scalp and shampooing are strongly advocated. There is a discussion of the relation of eye-strain, and directions on the proper wearing of glasses.

J. W. Courtney, in discussing the hygiene of the nervous system, naturally begins with the influence of hereditary and educational environment. There are excellent chapters on worry, overwork, neurasthenia, alcohol, rest and exercise. This article is one of the strongest in the book.

Dr. Stewart closes the work with a short chapter on the physiology of the muscular movement. This includes exercise and muscular training.

On the whole the work is an excellent contribution to hygiene, and it is all the more valuable from the fact that there is no attempt made in its pages to make every man his own physician.

HAYDEN ON VENEREAL DISEASES. A Pocket Text-book of Venereal Diseases. For Students and Practitioners. By James R. Hayden, M.D., Chief of Clinic and Instructor in Venereal and Genito-Urinary Diseases in the College of Physicians and Surgeons, New York, etc. New (3d) Edition, thoroughly revised. In one handsome 12mo. volume of 304 pages with 66 engravings. Cloth, $1.75 net. Flexible leather, $2.25 net. Co., Publishers, Philadelphia and New York.

Lea Brothers &

It speaks well for the popularity of this little work that it has promptly come to its third edition. This opportunity has been utilized to revise it thoroughly.

New sections on vegetations and herpes progenitalis have been added, and also a number of new illustrations. The book furnishes in clear and compact form a practical working knowledge of gonorrhea, stricture, chancroid and syphilis, together with their complications and sequelæ. It will be found very convenient and handy for students, but will also serve as a reliable guide for the practitioner in the management of this class of cases.

BACTERIOLOGY AND SURGICAL TECHNIQUE FOR NURSES. By the late Emily M. A. Stoney, Superintendent of Training School for Nurses, St. Anthony's Hospital, Rock Island, Ill. 190 pages. Philadelphia and London: W. B. Saunders & Co. Price, $1.25 net. Illustrated. 1901.

This is an admirable little book for the purpose for which it was written.

The first sixty pages are devoted to a general statement of a history of bacteriology, bacteria as the cause of disease; the theory of antitoxins, antiseptics and disinfectants and deodorants.

Then follows the practical portion of the work, which deals with such topics as the care of the operating room, the methods of sterilization, and the care of instruments.

There is a special chapter on gynecological examinations and operations, and there is an excellent one on operations in private practice. The directions regarding anesthesia are excellent, and nothing is to be desired in the description of surgical dressings. The preparation of the patient is carefully given.

The work closes with a brief description of the signs of death and method of preparing for autopsies.

For a work that deals with such a mass of detail, it is exceedingly practical. In this, we judge, its greatest value will be found, not only to nurses, but for all who read its well-written pages. Every nurse will be a better nurse for the reading of this book of Miss Stoney's.

THE MEDICAL NEWS POCKET FORMULARY, NEW (4TH) EDITION. Containing 1700 prescriptions representing the latest and most approved methods of administering remedial agents. By E. Quin Thornton, M.D., Demonstrator of Therapeutics, Pharmacy and Materia Medica in the Jeffer son Medical College, Philadelphia. New (4th) edition, carefully revised to date of issue. In one wallet-shaped volume, strongly bound in leather, with pocket and pencil. Price, $1.50 net. Lea Brothers & Co., Philadelphia and

New York, 1902.

The demand for a work of this kind is often exigent with the practitioner, for while he may know just what he desires to use in the treatment of a given case, the proper combinations of remedial agents may momentarily escape him. It is a book that will never prove a superfluous addition to the physician's equipment for successful practice, and indeed, may be the means of relieving him of an embarrassing situation at a most opportune moment.

In this new fourth edition of the Formulary are incorporated those newer remedies which have successfully stood the test of practical experience, and many newly originated formulæ have been added.

PROGRESSIVE MEDICINE, VOL. IV, 1901. A Quarterly Digest of Advances, Discoveries and Improvements in the Medical and Surgical Sciences, Edited by Hobart Amory Hare, M.D., Professor of Therapeutics and Materia Medica in the Jefferson Medical College of Philadelphia. Octavo, handsomely bound in cloth, 400 pages, 13 illustrations. Per annum, in four cloth-bound volumes, $10.00. Lea Brothers & Co., Philadelphia and New York.

Progressive Medicine in now one of the best known of the works devoted to the exposition of progress that is being made in medicine and surgery, and its readers number a large proportion of the progressive physicians of America.

The contents of this volume are of a varied and practical character, and appeal to all classes of medical men. One of the most interesting sections is that on Hygiene, by Dr. Baker, which is rendered more so by recent developments in the great question of tuberculosis. This system is not a mere compilation of literature, but presents a series of critical reviews and original papers by masters of the subjects of which they treat.

AMERICAN EDITION OF NOTHNAGEL'S ENCYCLOPEDIA. Variola, Vaccination, Varicella, Cholera, Erysipelas, Whooping Cough, Hay Fever.

VARIOLA (including Vaccination), by Dr. H. Immermann, of Basle. VARICELLA, by Dr. Th. von Jürgensen, of Tübingen. CHOLERA ASIATICA and CHOLERA NOSTRAS, by Dr. C. Liebermeister, of Tübingen. ERYSIPELAS and ERYSIPELOID. By Dr. H. Lenhartz, of Hamburg. WHOOPING COUGII and HAY FEVER, by Dr. G. Sticker, of Giessen. Edited, with additions, by Sir J. W. Moore, B.A., M.D., F.R.C.P.I., Professor of the Practice of Medicine, Royal College of Surgeons, Ireland. Handsome octavo volume of 682 pages, illustrated. Philadelphia and London: W. B. Saunders & Co., 1902. Cloth, $5.00 net; Half Morocco, $6.00

net.

To those physicians who have had an opportunity to see the first volume of this monumental work, it will not seem extravagant for us to state that this will undoubtedly prove one of the most valuable acquisitions that recent years have seen added to medical literature.

This new volume comes at a time when it will, on account of some of its articles, receive even wider attention than ordinarily, for it contains a most timely article on variola, including vaccination and variolation, which was prepared by Dr. Immermann, who is well known for his various contributions to this subject. Other articles contained in this volume are not less interesting and valuable, and the practitioner cannot but be pleased with the manner in which the subjects have been handled.

EXTRA-GENITAL CHANCRES,

WITH ILLUSTRATIONS AND REPORT OF CASES.*

BY M. GOLTMAN, C.M., M.D.

MEMPHIS.

BECOMING impressed with the number of extra-genital syphilitic chancres that I have seen in the past six years, I have concluded that a consideration of the etiologic factors concerned in their production might prove advantageous.

Firstly. Advantageous to us as medical men, from the strictly scientific or etiologic standpoint; and

Secondly. Advantageous to the public at large, from the hygienic standpoint.

In studying this particular part of the subject of syphilis, one cannot fail but to be almost startled by the many avenues of possible infection, almost anything being capable of carrying and transmitting the disease. That we do not all become infected depends upon three facts and one factor.

1. The fact that all normal individuals resist disease to a greater or less extent, syphilis not excepted.

2. The fact that many of us have more or less inherited immunity.

3. The fact of virus attenuation.

4. The factor-bull-headed luck.

Read before Tri-State Med. Assn. (Miss. Ark. & Tenn.) Memphis, Nov. 20, 1901

VOL. XXII-9

113

Bearing upon the question of immunity, an eminent syphilographer says very tersely, "We are fast becoming a nation of syphilitics." He might have said we are fast becoming a world of syphilitics, and still be correct.

Being concerned with syphilis insontium or innocent syphilis, it might here be well to state that Fournier showed that 25 per cent. of female syphilitics in his private practice acquired the disease innocently. Fordyce and others in this country claim even a larger percentage.

Realizing the importance of the subject from the figures just quoted, to say nothing of my own experience, which is more than confirmatory, this communication is the result.

All chancres are strictly speaking accidental, but we prefer to elevate the extra-genital induration, innocently acquired, to this distinction. The accidental chancre occurs then in from 2 to 5 per cent. of all syphilitics according to geographical location. In America it occurs in about 2 per cent. of all In certain sections of Europe where the habit of promiscuous kissing is common, it occurs oftener. According to statistics collected from different authors by Julien, out of 1977 syphilitic chancres 126 were extra-genital, or over 6 per cent. Of this tabulation 22 per cent. were in women.

One-half of all syphilitic chancres are cephalic, and of all cephalic chancres three-fourths are of the mouth. The female nipple is the next commonest site of infection.

Morrow, vol. 2, page 69, totals 9058 extra-genital chancres. Of these 1810 were of the lips, and 1148 were of the nipples and breast. Most of these, particularly those of the nipples and breasts, were no doubt innocently acquired. 372 were of the eyelids and conjunctiva, 146 of the chin, 145 of the cheek, 100 of the nose, 37 of the forehead and temple, and 27 of the ears. Tonsorial infection may in a great measure be held accountable for these last two items. 745 were acquired by cupping and phlebotomy, 179 by circumcision, and 82 by tattooing. These figures certainly show how common is syphilis insontium, without going into its truest type-hereditary syphilis.

As already stated, the avenues of infection are many and various. The secretion of the primary sore, so called, or of