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In the more advanced cases in which the whole larynx is carcinomatous one must naturally perform a total extirpation with or without removal of the cricoid. In cancer of the epiglottis he has carried out subhyoid pharyngotomy. With the exception of the first six cases of cancer of the larynx on which he has operated, he always operates in two stages. Tracheotomy is done five or six days before the major operation, and is usually a high tracheotomy, which allows the patient to become accustomed to the changed breathing situation and permits any irritation to subside. At the principal operation the Trendelenburg cannula with the funnel for anæsthesia is used.

The operations on the cases reported are of too recent date for one to speak of permanent results. Only three are of a longer duration than three years, and of these two are free from recurrence and one has died of it. It is noteworthy that in all cases where the carcinoma originated in the epiglottis, or had attacked it during the further progress of the growth, there was a recurrence within a year in the original site of the carcinoma. Three recurred in the tongue and one in the tonsil.

Without doubt, carcinoma of the epiglottis has a worse prognosis than that of the vocal chords, due to the rich lymphatic supply of the epiglottis, while the supply of the vocal chords is very defective.

The only case of death that he has to record at the conclusion of the operation cannot, as he says, be placed to the account of the method of packing, as in this case the patient was able to swallow quite well. The acute broncho-pneumonia followed hæmorrhage from a vein of the thyroid gland, and the patient had inspired a good deal of blood.



The Elements of Mammalian Anatomy, with special reference to the Cat. By ALVIN DAVISON, Ph D.; pp. 242; illustrations 108 London Rebman, Limited. 7s. net.

THE above book is the last of a number of monographs devoted to the anatomy of the cat; it is, however, one of the least exhaustive. The method chosen by the author of treating his subject is good. After an introduction, in which he gives a classification of the animal kingdom, we have a description of the various systems of the cat in eight chapters; at the close of each the more striking variations met with amongst other mammals are mentioned. The book is copiously and well illustrated, the lettering being, however, frequently indistinct and cumbersome. The text is accurate and lucid, although, as in so many other text books, it is implied that the rabbit is devoid of a vermiform appendix. Some unusual wording and phrasing are found, such as "mesal," "caudad," "cephalic portion of the cranium," and "caudal portion of the nasal fossæ," but they are readily understood with the help of the


The book, without possessing any distinguished merit, should prove of use to those students who wish to obtain a superficial and general knowledge of mammalian anatomy.

"The Lymphatics." By P. POIRIER, B. CUNEO, and G. DELAMERE. Translated and edited by CECIL H. LEAF. 117 illustrations. London: Archibald Constable and Co. 18s. net.

THIS is a book for which we have the highest praise. The subject is one of great importance and interest to both the diagnostician and the operating surgeon; it is, further, treated

in a most able and exhaustive manner. The great advance in our knowledge of the subject which it marks is attributed to the use of Gerota's method of Prussian blue injection, a full description of which is given in the text. The first half of the book is taken up with a consideration of the general anatomy of the lymphatics by Delamere, and we here find a useful summary of our knowledge of the leucocytes.

Perhaps the most interesting statement made is that "the lymphatics in a given region pass through three distinct glandular stages during their course." "The knowledge of these relays of glands placed in succession one behind the other in the lymph stream, is interesting from a pathological point of view, for they constitute so many stages at which the spread of infections and cancers is temporarily arrested.”

The most valuable portion of the book deals with the regional lymphatics and lymphatic glands, which have been described in great detail. The text is very considerably aided by numerous well-chosen and excellent illustrations. We might instance the figures showing the distribution of the lymphatics of the tongue and breast as likely to prove of great use and benefit. The translation is in every way worthy of the work, and all concerned are to be heartily congratulated upon its production. The only fault we can find with it is the strange omission of an index.

A Practical Text-Book of the Diseases of Women. By ARTHUR H. N. LEWERS. Sixth edition. H. K. Lewis, 136, Gower Street, London, W.C. 1903.

A TEXT-BOOK that has arrived at the sixth edition has abundantly justified its position. In the present edition the author has again thoroughly revised the book and brought it up to date. The extra-peritoneal method of abdominal hysterectomy is, very properly in our opinion, omitted. The introduction of illustrative cases, of which there are seventy-four, is one of the special features of this hand-book, and materially helps to increase the interest of the reader. For students and young practitioners it still retains its position as one of the best of the smaller gynæcological text-books in the language.

Practical Gynecology. A Comprehensive Text-Book for Students and Physicians. By E. E. MONTGOMERY, M.D., LL.D. Second revised edition. Rebman, Limited, 129, Shaftesbury Avenue, London, W.C. 1904.

THIS is a good example of a large class of American textbooks, and that it has found an appreciative audience is shown by the fact that in less than four years a second edition has been called for. The first edition has already been reviewed in these pages, and it need only be said that in the preparation of the present one much labour and thought have been expended. Many alterations in the arrangement of the different divisions of the subject have been made, and in the portions dealing with genital tumours extensive changes have been introduced, especially in the discussion of myomata and malignant growths. The author has devoted special attention to detailed descriptions of recent operative procedures, and in order to accomplish this the greater part of the work has been re-written, and 70 pages added to its size. The book can be recommended as affording a good account of the diseases with which it deals. Many new illustrations appear in the present edition, and are on the whole great improvements. Evidence of haste appears here and there; there are a few errors of spelling, such as liomyoma on page 602; this, of course, may be the American method of spelling the word, but the same excuse can hardly be urged for "Gregg" Smith on page 557. The illustrations 487 and 488 of cancer of the body of the uterus have apparently been transposed. The book is well got up, the printing is clear, and there is a very full index, which adds greatly to the value of the work.

Saunders' Year Book of Medicine. Edited by GEORGE M. GOULD, M.D. London: W. B. Saunders and Co.

YEAR BOOKS are difficult to review, in that they contain such a wide range of subjects. Their merit consists in the impartiality and thoroughness of their work. In the case of “Saunders' Year Book" it may be said that no important

paper or investigation of the year has escaped notice. The contents are arranged under the headings: Pediatrics, Pathology, Neurology, Legal Medicine, &c. We consider the method followed extremely good, and the book will be of value to all engaged in research, whether in clinical medicine or any of the related departments.

A Manual of the Practice of Medicine. By A. A. STEVENS, M.D. Sixth edition. Philadelphia, New York, and London: W. B. Saunders and Co.

THIS is an entirely revised edition of a useful and practical introduction to the practice of medicine. It is in particular the section on diseases of the digestive organs that has been re-written, an account of the most modern methods of gastric diagnosis being now included.

The book is essentially one for the student preparing for examination, and as such is a good one. It does not, therefore, include much theory, is concise and practical. We notice omissions of some subjects which, though not common, may give trouble in differential diagnosis. Thus malignant growth of the kidney is not mentioned in discussing hæmaturia. Nor is malignant growth of the pleura included in the list of introthoracic diseases. We notice, further, that the pathology of jaundice is not quite in accordance with recent researches. With such exceptions, the book is certainly useful and sound.

Elements of Surgical Diagnosis. By A. PEARCE GOULD,
M.S.Lond., F.R.C.S. London:
London: Cassell and Company.
Third edition.

THE third edition of Mr. Pearce Gould's Elements of Surgical Diagnosis will be welcomed by the student, as it has been thoroughly revised and partly re-written. The usefulness of the book has in consequence been considerably increased. The advances in diagnosis which the last few years have seen are many, and now that surgical aid is sought in many acute

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