shock will be great. 3. It prevents operation in contraindicated conditions. 4. It gives us the patient's norm, and is a basis for future counts, so we may have warning of subsequent complications.

What is the minimum percentage of hemoglobin with which we may still operate? Mickulicż places it at 30 per cent, but one of Da Costa's cases with 40 per cent died on the table. The average opinion favors 50 per cent as the minimum limit. Ether narcosis causes an absolute reduction, because of the increased hemolysis. The resulting new corpuscles are deficient in hemoglobin. Dr. Brunn recited a series of cases showing that shock during operation followed the hemoglobin curve closely, and that resuscitation on the table became necessary when the hemoglobin fell very low. The post-operative leukocytosis lasted 3 days, though the usual idea is in favor of 24 hours. Will an operation for pus be followed by a post-operative rise if, e. g., there are 24,000? If the cavity is packed, yes; if not packed, no. 25 appendix cases, chronic and subacute, were reported; the average leukocyte count was 9000, the highest 15,000, the lowest 6000.

14 acute cases of appendicitis were reported, 11 of which were operated before pus formed. The average was 17,000, the highest 21,800, the lowest 14,000. The three pus cases gave a leukocyte count of 18,000, 21.000, and 29,000. Some cases showed a post-operative rise above the count preceding operation, and this reached its maximum on the third day after operation. A decreasing count signifies that the surgeon can await the interval. An increasing count with subsiding symptoms means danger and calls for operation. pus tube cases gave an average count of 25,000, but in one case there was no leucocytosis because the sepsis was so extreme.

8

Conclusion: With a blood count of 14-18,000 and falling, we can await the interval.

DR. BARBAT: If we are called during the first 24 hours we should operate at once, and the mortality percentage will be decreased. If called later we rely on the blood count to determine whether we can await the interval. In regard to tuberculosis we can determine by a differential count, even if 12,000 leukocytes are present. There is a decrease of the polymorphonuclear neutrophiles and small

mononuclears, also; while the large mononuclear leukocytes are increased.

DR. SHERMAN wished to know how soon after operation a fall in the leukocyte count can be expected.

DR. OPHULS: I recall a case operated on for hemorrhoids; the patient had leukocythemia and died. In regard to the hemoglobin it gives us nothing new, for the surgeon recognized this formerly in a practical way. I agree that the pathologist should not be expected to give an opinion based on the white blood count any more than a physician should be required to base an opinion on temperature alone.

DR. CAGLIERI: If the hemoglobin decrease has come on slowly I would feel more hesitancy about operating than if the decrease were due to a rapidly acting cause. I find that the increase in iodophiles is an important means of diagnosing tuberculosis.

DR. BRUNN: I agree with Dr Barbat to operate promptly, but think that even in such cases a blood count can and ought to be made while the surgeon is preparing to operate. The leukocyte subsidence after drainage is continuous, but varies with the condition of the patient, kind and severity of infection, etc. Packed cases show a post-operative rise even to 27-37,000.

The report of Dr. Caglieri's committee upon resolutions relative to the death of Dr. McCone was received.

A communication from the Secretary of the Homeopathic Society was received, announcing their satisfaction with the present State medical law and the manner of its enforce

ment.

A resolution was introduced and passed recommending Gov. Pardee, in substance, to appoint a man to fill the vacancy in the State Board of Health.

Adjourned.

FRANCIS WILLIAMS, M. D.

SAN FRANCISCO SOCIETY OF EYE, EAR, NOSE AND THROAT SURGEONS.

Meeting December 18, 1902, DR. GEO. W. MERRITT, Chairman for the evening.

DR. GEO. W. MERRITT showed a case of double descemetitis, with fixed and floating opacities in the vitreous.

The patient was a woman aged 22, the subject of hereditary syphilis. When she presented herself for treatment at the clinic one month ago, the vitreous was full of opacities, but under mixed treatment the opacities have so diminished that they are now hard to find.

DR. LOUIS C. DEANE showed a man, aged 62, for whom Dr. H. B. de Marville and he had built a nose from the skin of his forearm. The man had a rodent ulcer of the nose; which had destroyed the lateral cartilages and the right ala completely, leaving an unsightly and bad-smelling cavity. The ulcer had persisted for 14 years, and the operation was done one year ago. Several secondary operations were necessary; but the nose is now completely healed and looking well. Dr. Barkan asked Dr. Deane whether the X ray had been tried, and referred to several cases of skin epitheliomata which he had successfully treated by that agent. Dr. Deane stated that operative measures had been used for cosmetic reasons, though he also spoke of the good effect he had in the case of an epithelioma of the lip from solar rays, by which the temperature of the tumor had been raised from 200 to 400 degrees, and had totally disappeared.

DR. BARKAN showed two cases of coloboma of the lens and iris, both of which had the peculiarity of being placed upwards and outwards, although Fuchs states that coloboma of the iris is always downwards. In another case, a boy of about 20, there was marked proptosis of the right eye, with strong dilatation of the subconjunctival veins. No pulsation could be felt, nor bruit heard in the orbit. An anamnesis was not obtainable, the only thing bearing on the eye condition being the fact that the patient had been subject to very violent attacks of asthma. Dr. Eaton thought the cause was possibly a venous tumor. Dr. Payne thought the tumor had its origin in the asthmatic attacks. Dr. Powers suggested that there might be an aneurysma, although the absence of a bruit rather conflicted with that diagnosis. The absence of pain excluded. glaucoma, the mobility of the eyeball spoke against cellulitis, and the probable diagnosis, he thought, was a benign neoplasm. Replying to Dr. Deane, Dr. Barkan stated that he had not tried the effect of bending the head far forward, in order to see whether it would cause extreme

VOL. XLVI-8

protrusion, as in the case demonstrated by Dr. Merritt early in this year. Dr. Wiborn stated that he had seen two cases of orbital cellulitis due to ethmoidal trouble, but that he did not think there was any cellulitis present in this case.

DR. BRADY showed the picture and skull of a cat which had extreme megalophthalmos of the right side.

DR. DEANE exhibited some lantern slides illustrating diseases of the fundus of the eye. They had been developed in colors, and showed a new departure in this class of work.

The following were elected officers for the ensuing year: For President, Dr. Louis C. Deane; Vice-President, Dr. Redmond Payne; Secretary, Dr. M. W. Frederick; Treasurer, Dr. Geo. W. Merritt; Librarian, Dr. V. H. Hulen.

Literary Department.

Under the charge of WINSLOW ANDERSON, A.M., M.D., M.R.C.P.London; M.R.C.S.England; L.S.A. London, etc., Professor of Gynecology and Abdominal Surgery in the College of Physicians and Surgeons of San Francisco.

CLINICAL SURGERY. For the Instruction of Practitioners and Students of Surgery. By A. J. OCHSNER, B.S., F.R.M.S., M.D., Chicago, Surgeon-inChief, Augustana Hospital and St. Mary's Hospital; Professor of Clinical Surgery, Medical Department University of Illinois. In one large royal octavo volume of over 500 pages, with nearly 100 full-page half-tone reproductions of immediate drawings of actual clinical cases. Price, $6.00, cloth; $7.00, half morocco. W. T. Keener & Co., Medical Book. sellers, 90 Wabash Ave., Chicago, Ill.

Professor A. J. Ochsner, of whom we have known for many years, has written a most praiseworthy work on surgery. As an operator Dr. Ochsner's fame has extended through the width and breadth of the land, and we are very glad indeed to have the opportunity of reviewing his work. The volume is fully illustrated, carrying a large number of full-page half-tone plates which are very practical and thorough in character as well as original in form. The text is authoritative and readable in every way. The illustrations are all original, and it is essentially a twentieth century production which crowns the author with glory. The thousands of medical men who have watched Professor Ochsner's clinics will welcome this, his first great work, as

an old friend. The work is particularly rich in illustrations of abdominal surgery-a subject in which Dr. Ochsner excels. Although the volume comprises nearly five hundred royal octavo pages, every word has been written by the author and with the constant thought of brevity and conciseness. The work is essentially clinical in character. The high quality of paper, presswork and binding reflects great credit on the publishers. The volume may be said to adequately represent the "newer" surgery-the advanced technique-presented with a force and conviction fully warranted by the experience and position of one of the leading surgeons of the day.

TEXT-BOOK OF MEDICAL JURISPRUDENCE AND TOXICOLOGY. By JOHN J. REESE, M.D., Late Professor of Medical Jurisprudence and Toxicology in the University of Pennsylvania; Late President of the Medical Jurisprudence Society of Philadelphia. Sixth Edition. Revised by HENRY LEEFMANN, A.M., M.D., Professor of Chemistry and Toxicology in the Woman's Medical College of Pennsylvania; Pathological Chemist to the Jefferson Medical College Hospital; Vice-President (British) Society of the Public Analysts. Price, $3.00 net. P. Blakiston's Son & Co., 1012 Walnut Street, Philadelphia. 1902.

Already the sixth edition of Reese's Medical Jurisprudence and Toxicology has been called for. This is a thoroughly standard work which has been brought up to date. It is noted that phenol is becoming one of the most common agents for self-destruction, and that water-gas greatly increases the list of accidental poisonings. In most cases of poisoning the free washing out of the stomach is one of the best remedies. The employment of alcohol as an antidote to carbolic acid poisoning, the author notes, is an important step in advance over the old treatment. He also says the value of atropin in morphine poisoning is practically nil. The work is at once practical and complete. MOSQUITO BRIGADES AND HOW TO ORGANIZE THEM. BY RONALD ROSS, F.R C.S., D.P.H., F.R.S., Walter Meyers Lecturer on Tropical Medicine, Liverpool School of Tropical Medicine; Major, Indian Medical Service, retired. Longmans, Green & Co., New York. George Philip & Son, London. 1902.

A very instructive volume has been written by Professor Ronald Ross, giving the etiology, description and how to organize mosquito brigades. Now that it is well known that yellow fever, malaria and elephantiasis, if not many other diseases are due to infection by mosquitoes, this timely work will be of special interest to health officers and practitioners.