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history of the previous condition of the patient, as this is almost the only thing that will aid in making a differential diagnosis.

Treatment is of no avail in cases of such severity as those detailed by Park, but operation has been successful in cases of more limited gangrene.

It is interesting to note that in 1868 Chiene, of Edinburgh, recorded an instance of mesenteric occlusion not proving fatal. This was in the case of a dissecting-room subject, in which the branches of the coeliac and mesenteric arteries were found filled with the injecting material, while their main trunks were completely occluded by an old embolic process The cceliac axis was changed into a cord, and both mesenteric arteries were obliterated.

LEONARD GAMGEE.

REVIEWS.

A Text-Book of Surgery for Practitioners and Students.

Edited by WILLIAM W. KEEN, M.D., LL.D., F.R.C.S., and J. WILLIAM WHITE, M.D., Ph.D. Fourth Edition. Royal octavo; pp. 1,363; 39 plates; 590 illustrations. Thirty

Shillings. W. B. Saunders and Co. 1903. DR. KEEN and DR. J. WILLIAM WHITE have presented in their American Text-Book of Surgery a work which has attained a great popularity during the two years of its existence, no less than 40,000 copies having been disposed of. The book is compiled on the modern plan of the “system“ by many contributors, and has the inequality and want of continuity inseparable from works of this typé. After a careful perusal of the book, we are not sure whether the editors intend it to compete with the year-books of surgery or to be a presentation of modern surgery based on well-weighed evidence of widely-accepted theories and practice. The most recent, up-todate, and most advanced of work is included, but at times in a somewhat sketchy manner which detracts from its value. Chapter II., on the examination of the blood in its relations to surgical diagnosis and treatment, is an example of what we mean : reflections are made on the value, and conclusions are drawn from the results, of estimations of, the hæmoglobin value, the leucocyte ratio, iodophilia, freezing point of the blood (and urine) from the kidneys, and the coagulation time of the blood; but no description of the methods by which the student or practitioner undertakes these proceedings is given in the text.

The book deals with general, special, regional, and operative surgery. In the first part the subject of syphilis is very satisfactorily presented. Rickets, scurvy, and tetanus are very cursorily dealt with. In the chapter on Tumours, Cohnheim's views as to their origin from embryonic “rests" are favoured by the writer. The classification of an English surgeon is more or less closely adopted. The illustrations in this section are not typical; they represent what is unusual, monstrous, and often horrible.

Part II., Special Surgery, contains a good chapter on diseases of bones, and fractures. The operative treatment of recent fractures is deprecated, and the use of massage and passive movement is alluded to with scepticism. Orthopædic Surgery is briefly dealt with, and then chapters on

diseases of joints and dislocations follow. There is an interesting chapter on the surgery of the nerves. We find no mention of congenital dislocation of the hip, or of ischæmic paralysis of the forearm. Book III., Regional Surgery, opens with a good account of diseases and injuries of the head. Affections of the spine, respiratory organs, and neck are accorded rather superficial notice, and this comment applies also to the account of affections of the mouth and tongue. Enough stress is not laid on the significance of pre-cancerous conditions of the tongue; while the difficulties of diagnosis between the more severe ulcers of this organ are not impressed on the reader with the insistence that their frequency warrants.

There are

no illustrations of these lesions.

Affections of the abdomen are described at some length. The chapter on the surgery of the genito-urinary tract is satisfactory : exception might be taken to the statement that congenital cystic kidneys are never “diagnosticated during life, as they produce no distinctive symptoms.

The section upon Operative Surgery has a good account of the principles of antisepsis and methods of preparation of the skin, instruments, and appliances for an operation. Anæsthesia receives adequate attention. There are a number of very useful anatomical plates illustrating the surgery of the arteries. Short chapters on minor surgery and bandaging, X-rays in surgery, and on military, naval, and tropical surgery complete the work.

From what we gather by carefully going through this book, we can understand its wide popularity and welldeserved reputation. Compiled by distinguished surgeons under the able co-editorship of Drs. Keen and White, its contents have an assured worth. It covers an immense range of its subject, and touches on all of the most modern in surgery. But it has the faults of the time: it touches on the subject in a discursive way rather than attempting to present it exhaustively. If the object of a text-book is to present the subject in such a way as to teach it to the student, then this is not a text-book. It assumes in many chapters, at least—a certain familiarity of the subject to the reader, and to such it cannot but serve as a most valuable epitome of modern surgery. The book appears bound in two handsome volumes The publishers are to be congratulated on the excellence of the paper, print, and illustrations. We suggest that in the next edition a note that Volume II. begins on page 625 should be printed at the head of each page of the index.

Medical Laboratory Methods and Tests. By HERBERT

FRENCH, M.A., M.D. (Oxon.), M.R.C.P. (Lond.), Medical
Registrar, Guy's Hospital; Gillson Scholar, Society of
Apothecaries of London; Radcliffe Travelling Fellow,
Oxford University. 152 pages, with 72 illustrations.

London: Baillière, Tindall, and Cox. Price 3s. 6d. net. THE author states in the preface that the book is intended to be a small hand-book for the medical laboratory, and we venture to think that it will prove of distinct value both to the student of medicine and to the practitioner. It is a very practical little book, clearly written, and giving a large amount of information. It does not enter into an examination of the patients, but describes in detail the more common methods of examining the fluids and other substances obtained from them, pointing out the various fallacies to which each test is liable. The first chapter is devoted to the examination of the urine, and in it are described its general characteristics, the urinary deposits, the tests for the substances in solution, and the methods of estimating the amount of its various constituents. In Chapter II. a good description is given of the methods of examining the blood, with the composition of the different fluids and staining reagents in common use. There is also a short account of the serum reaction for typhoid fever. Chapter III. deals with the naked-eye and microscopical characters of the sputum, the importance of the various appearances being clearly indicated. The methods of the examination of pus are described in Chapter IV., and a short account is given of the chief pathogenic organisms. Chapter V. is perhaps the best in the book, and contains the chemical and microscopical examinations of the gastric contents, with a short description of the different test meals. The next chapter is concerned with the examination of the fæces, and contains a description of the parasites which are found therein. The following two chapters are reserved for the microscopical examinations in the affections of the skin, for the examination of serous exudations, cerebro-spinal and cystic fluids. The last chapter contains a short account of the tests for the more common poisons. This little book is profusely illustrated with drawings, which add greatly to its value, but it is in reference to these that we make our only adverse criticism, for we consider that some of the drawings are too rough, and, in consequence, do not give quite an accurate picture of the objects they are intended to represent. This small blemish, however, is quite outweighed by the merits of this excellent little volume. “Medical Laboratory Methods and Tests” seems to meet a need which has long been felt for a small hand-book on this important branch of clinical diagnosis.

Manual of Operative Surgery. By H. J. WARING, M.S., M.B.,

B.Sc., F.R.C.S. Second edition, pp. 645; 472 figures.

Published by Young J. Pentland. This is one of the best of the excellent series of students' manuals. It is familiar to us as the text-book in use at “Bart's ” in the course of operative surgery for the F.R.C.S. and M.S. examinations, for which it contains quite enough. The arrangement of the book is such as is the most convenient for this purpose, dealing with operations on the trunk first and then taking in order the neck, mouth, head, and spinal column, nose, and ear, before treating with operations on the limbs. But there is much besides the work of the operative surgery class: there are useful sections on Ophthalmic operations, and on plastic surgery, the treatment of strangulated hernia, retention of urine, etc., which raise the book from a mere class manual to the level of a reliable hand-book for the use of practitioners engaged either in general or hospital work. The indications for the various operations are given briefly before the description of the performance of the operations, and a very useful account is given of the practical and every-day methods of attaining asepsis in the preparation for and conduct of an operation, in the preliminary chapters of the book. Some of the illustrations are too small. Fig. 338 is not a good one, and the line of the incision in Fig. 344 is too oblique. No mention is made of the use of Wyeth's pins for use with the tourniquet in amputation through the hip and shoulder joints. But the object of the author to be as practical and concise as possible makes it necessary to use small figures and to omit descriptions of all the varieties of the same operation. As to the value of the manual, we have no hesitation in stating that it is the best text-book, within its scope, in its subject, and we readily recognise the success which Mr. Waring has obtained with this book. We have much pleasure in recommending it to students and practitioners.

The Medical Annual : A Year Book of Treatment and Prac

titioner's Index, 1904. Twenty-second year. Pages, 999.

Bristol : John Wright and Co. THIS issue of Messrs. Wright's well-known publication fully maintains the reputation gained by previous volumes. The range of subjects dealt with is wide and fully up to date. There is no doubt that, for the busy practitioner whose time for reading is limited, the Medical Annual is a most valuable publication.

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