Textbook on the Therapeutic Action of Light. By Corydon Eugene Rogers, M.D., formerly Demonstrator of Anatomy in the University of New York. Small octavo, pp. 323. Illustrated. Published by the author.

In this book the author has presented his experience in the employment of light as a therapeutic agent in the treatment of various diseases. By the aid of a specially constructed lamp of not less than 600 candle power, controlled by special reflectors, he has been able to produce what he calls new rays, or rho rays, which, when projected upon the human body, not only penetrate but pass entirely through the tissues, including the bones." If the writer has succeeded in relieving the many diseases he describes he is to be congratulated. A test will be to buy the book, read it and apply its methods in treatment.

J. A. R.

Veterinary Anatomy. By Septimus Sisson, S.B., V.S., Professor of Comparative Anatomy, Ohio State University, College of Veterinary Medicine. Octavo of 826 pages, 528 illustrations. Philadelphia and London: W. B. Saunders Company, 1910. (Cloth, $7.00; half morocco, $8.50, net prices.)

The lack of a modern and well illustrated book on the structure of the principal domestic animals has been acutely felt for a long time by teachers, students, and practitioners, of veterinary medicine. The work here offered is the expression of a desire to close this gap in our literature. The experience of the author during the last ten years has demonstrated that many of the current descriptions of the organs in animals contain the same sort of errors as those which prevailed in regard to similar structures in man previous to the adoption of modern methods of preparation. In this work an attempt is made to eliminate some terms which do not appear to fulfil any useful purpose and others which are clearly erroneous or otherwise undesirable, and to offer a textbook of convenient size for the student and a guide of ready reference for the practitioner.

J. A. R.

A Manual of Operative Surgery. By Sir Frederick Treves, Bart., G.C.V.O., C.B., LL.D., FRCS, Sergeant-Surgeon to H.M the King, and Jonathan Hutchinson, F.R.C.S., Surgeon to the London Hospital. Third edition. In two octavo volumes. Volume II, 820 pages, with 302 engravings, and 8 full-page plates. Lea & Febiger, Publishers, Philadelphia and New York, 1910. (Halfmorocco, $6.50, net.)

Mr. Hutchinson, the associate of Sir Frederick Treves in the authorship of the manual, makes apology for the delay in the publication of this volume, which he says was due, at least in large part, to the amount of time and labor incident to the revision of the whole work because of the numerous additions and alterations made to it. This volume contains parts three and four, and a number of excellent plates, besides many new illustrations in the text. The third part deals with operations on the neck and spine, while the fourth part presents operations on

the thorax and breast. The first two chapters in the third part relate to operations on the skull and brain and to operations on the middle ear and mastoid antrum, and have been revised, even largely rewritten by Mr. A. J. Walton, while the chapter on tendon suture and tendon grafting is entirely his work.

It is a genuine pleasure to possess this completed treatise, for it places in our hands,—in the hands of the medical profession of America, the experience of two of the greatest of British surgeons. It is pleasant to be able to refer to plastic operations, as set forth by text and illustration in this work. Treves and Hutchinson cling to the traditions of surgery and present the classic operations of the whole surgical domain while, at the same time, adopting every modern method. Every surgeon will feel great satisfaction in keeping this work close at hand for convenient reference.

BOOKS RECEIVED

For the

The Essentials of Histology, Descriptive and Practical. use of students. By Edward A. Schäfer, F.R.S., Professor of Physiology in the University of Edinburgh. New eighth edition, thoroughly revised. Octavo, 571 pages, with 645 illustrations. Lea & Febiger, Publishers, Philadelphia and New York, 1910. (Cloth, $3.50, net.)

Pathogenic Microorganisms, including Bacteria and Protozoa. A practical manual for students, physicians and health officers. By William H. Park, M.D., Professor of Bacteriology and Hygiene in the University and Bellevue Hospital Medical College, and Director of the Research Laboratory, Department of Health, New York City; and Anna W. Williams, M.D., Assistant Director of the Research Laboratory. Fourth edition, thoroughly revised. Octavo, 670 pages, with 196 illustrations and 8 full-page plates. Lea & Febiger, Publishers, Philadelphia and New York, 1910. (Cloth, $3.75, net.)

Obstetrical Nursing for Nurses and Students. By Henry Enos Tuley, A.M., M.D., Professor of Obstetrics, Medical Department University of Louisville. With seventy-three illustrations. Seond edition. John P. Morton & Company, Publishers, Louisville, Ky., 1910. (Cloth, $1.50.)

The Practice of Medicine. A guide to the nature, discrimination and management of disease. By A. O. J. Kelly, M.D., Assistant Professor of Medicine, University of Pennsylvania. Octavo, 949 pages, illustrated. Lea & Febiger, Publishers, Philadelphia and New York, 1910. (Cloth, $4.75, net.)

International Clinics. A Quarterly of Illustrated Clinical Lectures and especially prepared articles on Treatment, Medicine, Surgery, Neurology, Pediatrics, Obstetrics, Gynecology, Orthopedics, Pathology, Dermatology, Ophthalmology, Otology, Rhinology, Laryngology, Hygiene, etc. Edited by Henry W. Cattell, M.D. Vol. III, twentieth series. Philadelphia and London: J. B. Lippincott Co.

1910. (Cloth, $2.00.)

A Treatise on Orthopedic Surgery. By Royal Whitman, M.D., Adjunct Professor of Orthopedic Surgery in the College of Physicians and Surgeons, New York; Professor of Orthopedic Surgery in the New York Polyclinic. Fourth edition, revised and enlarged. Octavo, 908 pages, with 601 illustrations, mostly original. Lea & Febiger, Publishers, Philadelphia and New York. 1910. (Cloth, $5.50, net.)

The Practice of Surgery. By James Gregory Mumford, M.D., Visiting Surgeon to the Massachusetts General Hospital; Instructor in Surgery in the Harvard Medical School. Octavo, pp. 1015. With 682 illustrations. Philadelphia and London: W. B. Saunders Co. 1910. (Cloth, $7.00.)

The Practical Medicine Series. Ten volumes. Under the general editorial charge of Gustavus P. Head, M.D. Vol. V. Obstetrics. Edited by Joseph B. DeLee, M.D. Vol. VI. General Medicine. Edited by Frank Billings, M.D., and J. H Salisbury, M.D. Series 1910. Chicago: The Year Book Publishers. (Prices, $1.25 and $1.50; entire series, $10.00.)

Manual of Physiology with Practical Exercises. By G. N. Stewart, M.D., Professor of Experimental Medicine in Western Reserve University, Cleveland. Sixth edition. Small octavo, pp. 1084. trated. New York: William Wood & Co. 1910. (Cloth, $5.00.)

Illus

Biology, General and Medical. By Joseph McFarland, M.D., Professor of Pathology and Bacteriology in the Medico-Chirurgical College of Philadelphia. 12 mo, pp. 440. With 160 illustrations. Philadelphia and London: W. B. Saunders Co. 1910. (Cloth, $1.75.)

Practical Points in Nursing. By Emily A. M. Stoney. Fourth edition. 12 mo, pp. 495. Illustrated. Philadelphia and London: W. B. Saunders Co. 1910. (Cloth, $1.75.)

A Treatise on Diseases of the Eye. By John E. Weeks, M.D., Professor of Ophthalmology in the University and Bellevue Hospital Medical College, New York. Octavo, pp. 944, with 528 illustrations and 25 full-page plates. Lea & Febiger, Publishers, Philadelphia and New York, 1910. (Cloth, $6.00, net.

Lea's Series of Medical Epitomes. Edited by Victor C. Pedersen, M.D., New York. An Epitome of Hygiene and Public Health. By George M. Price, M.D., formerly Inspector New York State Tenement Commission, Medical Sanitary Inspector, New York Department of Health. 12 mo, 255 pages. Lea & Febiger, Publishers, Philadelphia and New York. 1910. (Cloth, $1.00, net.)

LITERARY NOTES

REBMAN Company, medical publishers, 1123 Broadway, New York, have just issued a new catalogue comprising a number of important books of recent issue. It is handsomely printed on well finished tinted paper and is completely indexed. It is accompanied by a list of art prints for the waiting room and home of the doctor. It will be furnished on application.

F. A. DAVIS COMPANY, Philadelphia, have recently sent out a handsome catalague of medical works, which they publish in the most approved form. It contains numerous medallion portraits of the authors of the books they publish, is well indexed and is a convenient brochure of reference. For copies, address the publishers.

BUFFALO MEDICAL JOURNAL

VOL. LXVI.

DECEMBER, 1910.

ORIGINAL COMMUNICATIONS

No. 5

Some Abnormalities and Complications of the Pregnant State, with Report of Cases'

Including Ectopic Gestation, Fibroid Tumors, Appendicitis, Obstruction of the Bowel and Tuberculosis

BY L. G. HANLEY, M.D., LL.D.,
Buffalo, N. Y.

Gynecologist to Buffalo Hospital Sisters of Charity; Chief Obstetrician of St. Mary's Infant Asylum and Maternity Hospital; to Surgeon Providence Retreat; Consulting Obstetrician Erie County Hospital; Gynecologist to the Emergency Hospital; Consulting Surgeon to the Infant Home Lady of Victory; Surgeon to the New York Central Railroad Co.; former Clinical Professor of Obstetrics University of Buffalo, and Professor of Obstetrics, Niagara University.

T

HE term ectopic is derived from the Greek ektoños which means out of the normal place. The proper habitat for the fecundated ovum is the uterus, and when we use the term ectopic gestation we mean that the product of conception or pregnancy is extrauterine, or perhaps in a rudimentary horn of a bicornate uterus. Anything that will interfere with the transit of the ovum, whether it be congenital malformation, or some other pathological cause, will produce the condition known. as ectopic pregnancy.

The uterus is the home of the fetus, but frequently this product of conception in its youth does not go home but likes to wander from its own fireside, perhaps due to the obnoxious presence and results of the gonococcus, or the staphylococcus, or to the bacillus coli, that have spoiled its environment and surroundings, or perhaps it is due to "wanderlust." Whenever this happens it may possibly outlive its hobo life of wandering, go to full term and come home, like the prodigal, in an emaciated and starved condition; but the chances are as records show, that it will be cast by the wayside and die of starvation, its means of sustenance, that is, its blood supply, being cut off.

It matters not whether it leads tubal, ovarian, or abdominal existence, the treatment is the same and it is bound to receive surgical chastisement. Tubal is by far the most common and it is a question with some authors if all cases of ectopic pregnancy are not primarily tubal. If a diagnosis can be made before rupture, which is possible in nearly every case, then the dan

1. Read before the Buffalo Academy of Medicine, May 23, 1910.

ger is not so great as when rupture occurs. When rupture does occur then it is a question of "maximi momente" to open the abdominal cavity quickly and make a rapid operation.

The question of waiting after rupture has taken place, and the patient in great shock, the chances being that the shock may become still greater, has never appealed to me, for there is no telling when the plug in the bleeding aperture may break, hemorrhage start, and prove that procrastination was the thief that snatched the patient. We have seen rupture in ectopic cases where there was only little blood in the abdominal cavity, yet the patient was in extremis. One might say that here was a case where we could wait with propriety. I have seen cases where there was a great amount of blood in the abdominal cavity and the patient not in extreme shock. If that small amount of blood would produce a condition of extreme shock in one individual, what would a greater amount of blood do to the same individual? Each case is a problem in itself; and where certain individuals can stand only the effects of slight hemorrhages, others may withstand many times more without bad effect. There are many cases of extrauterine pregnancy that rupture and are absorbed, the patient experiencing very little inconvenience, and which have been discovered at a later period when the abdominal cavity was opened for some other pathological condition.

It is very seldom that extrauterine pregnancy goes to term, the early death of the fetus being due to its lack of nourishment. If there should be continuous hemorrhages a circumscribed hematoma may form in the pelvic cavity, which may become infected producing pelvic abscess with all its complications, dangers, peritonitis, suppuration and so forth. If there are repeated hemorrhages because the ovum is not wholly extruded, or not wholly absorbed, it may become infected, remain for a great length of time as an organised clot. This is the kind that can be operated with safety through the posterior culdesac. The same may be said when the tube ruptures downward between the folds of the broad ligament. It may be entirely extraperitoneal, and if of long standing may be opened from below.

"To know a subject thoroughly perhaps is not permitted unto erring mortals." But the symptoms of nearly all cases have something in common that lead to a very marked-like diagnosis. In the beginning it corresponds to normal pregnancy. Whether before rupture, after rupture, at time of rupture, and after peritonitis and suppuration have set in, there generally is a history of a missed period of menstruation, vaginal discharge, which may be scant in appearance whether this occurs shortly after