suprarenal extract, a small piece of adenoid tissue removed from the naso-pharynx. Three hours later excessive hemorrhage took place, which did not stop until the patient fainted. This might have been a vicarious hemorrhage, since the menstruation was expected at the time of operation, but only made its appearance after the hemorrhage had ceased.

The Case 2 was a girl, aged four, whose right tonsil was removed with a tonsillotome. On the fifth day after operation an alarming hemorrhage occurred, which was stopped with suprarenal extract, given per os, one grain every two hours.

M. TOEPLITZ.

149. The obstruction of the supratonsillar fossa by the plica triangularis predisposes to circumtonsillar suppuration. Recurrence of peritonsillar abscess is prevented by radical excision of upper part of tonsil, removal of the plica triangularis, and breaking up of adhesions. M. TOEPLITZ.

150. A woman æt. twenty-nine, with a family history of tuberculosis, had chlorosis with gastric ulcer when fourteen years old, coughed for several winters, had a pleurisy, and lost 28 pounds. She was operated for lacerated cervix and perineum, but exerted herself on the second, and exposed herself on the third day. Within two hours she had a chilly sensation with rapid rise of temperature to 103°, pulse 120. The next morning the temperature was still high, the skin was moist, the expression anxious, and restlessness prevailed; the throat felt a little sore, pharynx and tonsils were reddened, and the latter slightly swollen. The spleen, cervical, supraclavicular, axillary, epitrochlear, and inguinal glands were enlarged. Temperature, 101.6°. Pulse, 112. At noon, temp. 103°, pulse 118. Blood examination: hemoglobin, 65 %; reds 3,240,000, whites 1000. The leukocytes on the following day were 400 per cm; on the fourth day, 320. The temperature rose to 105.4°; pulse 120. The throat was now dark, the left side more involved. The swelling of the tonsils and œdema of the neighboring parts increased slowly; the pain was more intense on the fifth day. No fluctuation was felt. Edema became much larger and was scarified on the sixth day. Cultures made from the knife were the staphylococcus pyogenes albus and aureus. membrane formed over the wounded area. Regurgitation of food through the nose took place. Blood count made on each succeeding day showed a steadily decreasing leucocyte amount: 260

A

on the sixth day, until on the seventh, the day of death, which occurred suddenly from oedema glottidis, very few were found. Autopsy: A few old adhesions at the left apex pulmon., spleen much enlarged, epiglottis œdematous, posterior wall covered with decubitus and necrotic tissue above, oedema closed the glottis, neighboring glands greatly enlarged, and pharynx much inflamed. No pus; heart's blood, liver, bone marrow, epiglottis, vocal cords, and left kidney showed pure culture of staphylococcus pyogenes albus. Microscopical examination fully given.

M. Toeplitz.

151. An otherwise healthy man of forty-three years, suffered from the diffuse infiltration of the mucous membrane of the larynx and pharynx with pain, fever, and dyspnoea, the last being so great that tracheotomy had to be performed. Death ensued on the fifth day. At autopsy various abscesses were found in the tonsils. There were a number of irregular purulent ulcers in the pharynx and larynx. The submucous and muscular layers of the pharynx and larynx showed purulent infiltration, and connective tissue between the larynx and oesophagus was similarly affected. After discussing the differential diagnosis between abscess and erysipelas of the larynx, the author describes the bacteriological investigation which showed that the micro-organisms contained in the pus cells and discharge at autopsy were cocci very similar to the diplococcus pneumoniæ of Fraenkel-Weichselbaum.

PIFFL.

BOOK NOTICES.

I.

A Treatise on the Diseases of the Eye, Nose, Throat, and Ear. For Students and Practitioners. By Various Authors. Edited by Dr. W. C. POSEY, of Philadelphia, and Dr. JONATHAN WRIGHT, of Brooklyn.

In reviewing the ophthalmic part of this volume of 1238 pages, the writer's pen slipped in giving it a weight of fifteen pounds, whereas in fact it is only six pounds eleven ounces, but even with this reduction nobody will find it light-weight. The division of space gives 685 pages to the eye, 382 to the nose and throat, 125 to the ear, and 38 to a carefully prepared, double-column index. The authors of the different chapters on nose and throat are: J. L. GOODALE, of Boston. Histological pathology. descriptions with black and colored drawings. J. E. NEWCOMB, of New York. Methods of examinations, instruments and apparatus, and their use.

Minute

CH. W. RICHARDSON, Washington, D.C. Inflammatory diseases of the upper air-passages; hay fever (rhinorrhoeal, nasal, and cerebro-spinal); asthma; influenza.

W. K. SIMPSON, New York. Diphtheria; intubation; syphilis; tuberculosis; lupus and leprosy of nose and throat; chronic laryngeal stenosis; foreign bodies of nose and throat; rhinoliths.

W. E. CASSELBERRY, of Chicago. Neoplasms of the nose and larynx; the local, medicinal, and surgical treatment of the larynx.

ST. CLAIR THOMSON, London. Diseases of the accessory sinuses.

H. S. BIRKETT, Montreal. Diseases of the oro-pharynx (tonsils, etc.) and naso-pharynx (adenoids, etc.).

EMIL MAYER, New York. Neuroses of the nose and throat. F. E. HOPKINS, Springfield, Mass. External deformities of the nose; cleft palate.

The reviewer had to abstain from going into an analytical discussion of the different chapters above enumerated, but he can say

that the authors have demonstrated their competency and presented the subjects in the manner most congenial to the American reader. The numerous drawings are well enough executed to illustrate the authors' meaning and therefore greatly assist the student. It is gratifying to notice, in this and other modern text-books designed for the practitioner, that more stress is laid on the pathology of the disease, the physical methods of diagnosis, and the hygienic management of the patient than on internal remedies. This tendency is a wholesome antidote to the multitude of modern remedies with which high-pressure chemical works and enterprising drug firms flood the general medical journals, not alone in their advertising columns.

The last part of the big volume-which concerns us particularly is, we are sorry to say, disappointing. The arrangement of the subject-matter is so huddled that it makes the appearance as if the publisher or the editors, or both, wanted to be through with it as quickly as possible. The whole of otology-one of the most progressive and important departments of modern medicine in the fine differentiation of its anatomy, the marvellous, most interesting, and only partially-solved questions of its physiology and pathology, its intimate connection with the brain-functions being one of the mainstays of practical, I mean experimental not speculative, psychology, not to speak of its dominant influence on intracranial surgery: all of which is crowded to the end of this bulky volume and entrusted to only four men, who, it seems, worked disjointedly.

The first chapter, 22 pages, contains conventional description of the anatomy of the outer ear, its examination, a few instruments and illustrations (all borrowed),-on the whole an insufficient presentation. The second chapter (by E. A. Crockett, Boston), making a great jump, teaches us the internal ear, the auditory nerve, and deafmutism, all in 9 pages. The third chapter is substantial and fairly original (by Hy. A. Alderton, of Brooklyn), 67 pages, with many engravings, partly from the author's collection of the borrowed ones we may particularly mention three from Körner's Eitrigen Erkrankungen des Schläfenbeins as very instructive. The specimens from the author's collection are good, but what is of didactic value might be illustrated by fewer drawings more to the point. The reproduction (on p. 1120) of a figure from Bacon's Manual is much worse than the original (p. 358, 3d edition).

The last chapter, on chronic non-suppurative middle-ear disease, is by A. H. Cheatle, London. A short description on the hearing function introduces the exploration of the E. tube with a catheter too much curved for our people. Then follow the classification and description of forms of catarrhal otitis. media, accumulation of fluid in inferior part of the drum cavity, fixation of the stapes, etc., and the usual modes of treatment,— everything on 23 pages. The descriptions are quite to the point, mentioning, without exaggeration of expected results, the means best adapted; also stating candidly where special treatment is of no benefit.

H. KNAPP.

II. Transactions of the Otological Society of the United Kingdom. Vol. III. Third Session, 1901-1902. A neatly gotten-up volume of 125 small octavo pages. London: J. & A. Churchill, 7 Great Marlborough St. 1902.

The contents of this volume have been published in the abstracts we received through the kindness of the Hon. Secretary, Wm. Milligan. The volume is very neat, and gives the transactions in full, with engravings and photographs. They are very pleasant and instructive reading. We are sure that all Englishspeaking aurists, and a great many of other tongues, will regularly order these volumes. H. KNAPP.

III. We welcome the appearance of a general review of otology, to be published, in German, with the title Internationales Centralblatt für Ohrenheilkunde, herausgegeben von [edited by] Dr. O. BRIEGER, in Breslau, and Prof. Dr. G. GRADENIGO, in Turin, in conjunction with Dr. Cresswell Baber, Brighton; Prof. Dr. L. Bayer, Brüssel; Dr. E. S. Cassanello, Montevideo; Dr. J. Costiniu, Bukarest; Priv.-Doz. Dr. B. Gomperz, Wien; Prof. Dr. A. Guye, Amsterdam; Dr. C. R. Holmes, Cincinnati; PrivatJozent Dr. Krepuska, Budapest; Dr. H. Luc, Paris; Dr. E. Morpurgo, Triest; Privat-Dozent Dr. F. Rohrer, Zürich; Prof. Dr. E. Schmiegelow, Kopenhagen; Dr. Suné Molist, Barcelona; Privat-Dozent Dr. St. von Stein, Moskau; Prof. Dr. V. Uchermann, Kristiania; in twelve numbers a year, beginning January, 1903. Price, Mk. 16 [$4]. Publisher: J. A. Barth, at Leipzig, to whom to direct orders.

The Centralblatt will publish reviews (abstracts), exclusively, of all that refers to otology, including such publications on