relation of gall stones to the occurrence of acute pancreatitis, of Flexner, Opie, and others in relation to fat necrosis, and of the extensive investigations of Körte regarding pancreatic diseases.

As some of the results of these observers were not published until after the appearance of the German edition of this work the incorporation of the conclusions of these investigators in this edition is of special value.

The editorial work of the section on diseases of the pancreas closely follows the recently published and valuable work of Mayo Robson and Moynihan on that subject.

To the section on diseases of the suprarenal capsules is added the results of the investigations of Abel and Crawford, v. Fürth, Takamine, and others regarding the nature and therapeutic uses of suprarenal extract.

The section on diseases of the liver is edited by the late Dr. Packard. It is a worthy tribute to the careful, clinical observation, diagnostic acumen, and therapeutic skill of an accomplished man whose early demise we have cause to regret. This section is chiefly furnished by Quincke, HoppeSeyler writing the articles on neoplasms, parasites, and parenchymatous changes and degenerations.

The editor has given special attention to those contributions to the literature of diseases of the liver that are of later date than the German edition of the work, also to the diagnosis and therapeutic phases of the subject, including the surgical aspect of the treatment of liver diseases. Indeed the therapeutical value of this section rests largely on the contributions of the editor.

This work is of interest to the pathologist, surgeon, and clinician. It places in close contrast the results of the labor in these branches of investigation, and brings out strongly their interdependent features. Hitherto the investigations in these departments have been largely independent in connection with the liver and almost entirely so in regard to the pancreas and suprarenal capsules. The amalgamation of in

vestigation and results such as is obtained in this volume is therefore of marked benefit.

A TEXT-BOOK OF LEGAL MEDICINE AND TOXICOLOGY.-Edited by FREDERICK PETERSON, M. D., Chief of Clinic, Nervous Department of the College of Physicians and Surgeons, New York; and WALTER S. HAINES, M. D., Professor of Chemistry, Pharmacy and Toxicology, Rush Medical College, in affiliation with the University of Chicago. Two imperial octavo volumes of about 750 pages each, fully illustrated. Philadelphia, New York, London: W. B. SAUNDERS & CO., 1903.

This is one of the most comprehensive and authentic treatises on the subject of forensic medicine issued in recent years. It is not only very readable in the matter of presentation, language and arrangement; but it impresses one, as the leaves are turned and a fair idea of scope is gathered, as eminently practical in statement and deductions. This last point must stand, it is recognized, as the highest merit a work of this kind can have. Legal medicine, like legal matters in general, must possess a fixity of analysis upon which logical deduction can safely rest, and it is the finding of such a firm rock of resistance that demands both the purpose of the authors and the attention of the reader in a volume of the character before us, which is the first of the two, and is more especially devoted to questions concerned with the methods of production and the evidences connected with sudden and accidental death in which medico-legal questions may and do arise. Together with these subjects naturally occur those of expert medical evidence and post-mortem examination, the latter portion being contributed by Ludvig Hektoen than whom no one more able could have been selected.

The medical jurisprudence of railway injuries and that connected with life and accident insurance has developed to such an importance as to merit extended notice; and in this work we find several chapters given to these subjects, compassing the many and varied relations the medico-legal his

tory of the last several decades has brought out along this line.

The latter portion of this initial volume is taken up with Inebriety; The Stigmata of Degeneration; Insanity; Idiocy, Imbecility and Feeble-mindedness; and Mental Perversions of the Sexual Instinct. Hammond, Petersen, Eskridge, Jelliffe, and Chaddock are the several contributors of these lastmentioned subjects.

The section on Insanity is perhaps the most important, although this will not be fully enforced without the complemental portions of the subject announced to appear in the second volume, namely, the sections on Feigned Mental and Bodily Disorders: and Laws of the Various States Relating to the Commitment and Retention of the Insane.

There are a number of very excellent lithographic illustrations, as well as text half-tones, which lend interest to the general matter.

MEDICAL JURISPRUDENCE, INSANITY, AND TOXICOLOGY.— By HENRY C. CHAPMAN, M. D., Professor of Institutes of Medicine and Medical Jurisprudence in the Jefferson Medical College, Philadelphia. Third edition, thoroughly revised, greatly enlarged, and entirely reset. Handsome 12mo. volume of 329 pages, fully illustrated, including four colored plates. Philadelphia, New York, London: W. B. SAUNDERS & Co., 1903.

One desiring a brief, condensed exposition of forensic medicine will find this work of Chapman's satisfactory; but it must not be thought of as extensive in the least. For the senior student, or the recent graduate, it answers quite every purpose.

NOTES ON NEW BOOKS.

'Diseases of Metabolism and Nutrition." Obesity, Nephritis, Colitis. By Prof. Dr. Carl von Noorden. Authorized American translation. Edited by Boardman Reed, M. D., Philadelphia. E. B. Treat & Co., publishers, New York City.

One would gather from announcements that these separately issued volumes were of some size; as a matter of fact the three together would make a small book for the price.

The third edition of Griffith's "Care of the Baby" comes from the press of the Saunders Company. In point of directness and clear, common-sense advice and instruction nothing superior can be obtained.

The fourth volume of the present Practical Medicine Series of Year Books is devoted to "Gynæcology," ably edited by E. C. Dudley and Wm. Healy, of Chicago. volume is a presentable one; the illustrations are creditable, and the text substance very well worked over.

The

Clinical Review.

JULY, 1903.

Original Articles.

GASTRIC ULCER; ITS DIAGNOSIS AND INDICATIONS FOR SURGICAL INTERVENTION.*-By A. F. STEWART, M. D., Oneida, Ill.

In the surgery of the stomach we are interested, for the most part, in that which relates to gastric ulcer and its sequelæ. If we exclude surgical measures instituted for the relief of conditions due to traumatism, congenital malformations, etc., practically all other interests are involved in the relief of the immediate or remote results of ulcer.

The prevalence of gastric ulcer has until a comparatively recent date been much under-estimated. Mayo Robson, of England, estimates it from five to ten per cent. of every com munity.

It generally occurs in the second or third decades of life, in contra-distinction to carcinoma of the stomach, which is a disease of later life.

In females, as compared to males, ulcer exists variously in the proportion of three to one, and this factor has a special significance in that it relates to conditions peculiar to females during this period of life.

As to the direct causes of ulcer many theories have been advanced. Anæmia and angio-neurotic conditions incident to the adolescent age are most important factors. Associated with these such diseases as chronic nephritis, chronic hepatic

*Read before Knox Co. Medical Society, Galesburg, Ill., Apr. 21, 1903.