NEW PUBLIGATIONS.

NOSE AND THROAT WORK.

The appearance of a new general practitioner's manual of nose and throat work is evidence of a demand for such a volume, and Dr. Richards's new book is certainly entitled to a place of merit in the list. It is undoubtedly a most readable book, and carries between its covers a minimum of dead ballast. The author deals almost or not at all with theory, but gives plenty of useful information based upon clinical experience. The book is free from dogmatic assertion, is well arranged and indexed, and should be well received in the field for which it is intended. Dr. Richards is to be congratulated upon the work. There should be an early demand for a new edition of this volume.

Nose and Throat Work for the General Practitioner. By George L. Richards, M.D., Fellow American Laryngological, Rhinological, and Otological Society; Otologist and Laryngologist Fall River Union Hospital, Fall River, Mass. New York: Published by International Journal of Surgery Co.

ZIEGLER'S PATHOLOGY.

The tenth edition of this valuable work is an indication of the permanent position it has attained as an accepted text-book of the science of which it treats. It has been thoroughly revised, and is in all particulars thoroughly up-to-date. The translation has been made by Professor Warthin, of the University of Michigan. Many new and colored illustrations appear, and the publishers have spared no effort to make the work a successful presentation of the author's labors.

General Pathology. By Dr. Ernst Ziegler. Tenth Revised Edition. Translated and Edited by Aldred Scott Warthin, Ph.D., M.D. Royal 8vo, 784 pages, sumptuously illustrated by 586 engravings in black and many exquisite colors. Muslin, $5.00 net; leather, $5.75 net. New York: William Wood & Co.

COMPEND OF GYNECOLOGY.

The Quiz-compend series by Messrs. Blakiston has added a new edition to its hitherto successful one on gynecology. It describes several new operations, and is up-to-date in all particulars. This series of compends will continue to be very popular with students.

Quiz-Compends. Compend of Gynecology. By William H. Wells. M.D. Third Edition; 145 Illustrations. Philadelphia: P. Blakiston's Son & Co.

864

THE PROGRESS OF MEDICAL SCIENCE.

SURGERY.

THE OPERATIVE TREATMENT OF ASCITES.

Sinclair White (British Medical Journal, Oct. 10, 1903) says there is indisputable evidence that cirrhosis of the liver accompanied by ascites is not always a hopeless disease.

The ascites can be permanently cured in a considerable percentage of cases by operation.

There is reason for thinking that the operation of epiplorrhaphy may not only cure the ascites, but also lead to partial regeneration of the damaged liver cells.

Tapping alone has occasionally cured ascites, and should be tried once, or oftener, before proceeding with the more serious operation.

The operation of epiplorrhaphy is a formidable one and should only be undertaken in selected cases.

The divergent opinions respecting the significance of ascites in cirrhosis of the liver are best explained by assuming that the disease has more than one type, and that while in one class of cases, owing to the damage sustained by the hepatic cells, the patient is hopelessly incurable by the time ascites has appeared, in a second and probably more numerous class the incidence of the poison has fallen more especially on the hepatic connective tissue, leading to injurious pressure on the portal venous system and peritoneal effusion before the liver cells have become seriously damaged.

PROSTATECTOMY AND GALVANOCAUSTIC PROSTATOTOMY (BOTTINI'S OPERATION) THEIR PRESENT STATUS IN THE RADICAL TREATMENT OF THE HYPERTROPHIED PROSTATE GLAND.

Willy Meyer (Medical Record, Oct. 24, 1903) says that the operations making a direct attack upon the enlarged prostate are preferable to those aiming to exert an indirect influence. According to Meyer we have two useful procedures for the direct treatment of the enlarged prostate gland-i.e., prostatectomy and galvanocaustic prostatotomy (Bottini's operation).

In selecting the method indicated in the given case we must individualize and be guided by anatomic, pathologic, and social conditions.

Prostatectomy is the most radical and most surgical procedure; it should be the operation of choice whenever promising success. Perineal prostatectomy offers advantages over the suprapubic method, since it enables the operator to do the operation under the guidance of his eyes.

Debilitated patients who seem unfit subjects for the more radical operation should not be at once relegated to catheter life, nor should prostatectomy be performed in order "to let them down easy;" they should be advised to have Bottini's operation done if possible.

Surgeons should familiarize themselves with both methods in order to be in a position to do justice to their patients.

It is the duty of those refusing to do Bottini's operation under any circumstances to nevertheless advise the latter in cases in which the patient asks for more radical relief and the operation with the knife seems contraindicated.

Further carefully compiled statistics as to the late results of both operative procedures-preferably in the hands of one man— are desirable, in that they will increase our knowledge with reference to the selection of the proper method in the individual case.

SURGICAL TREATMENT OF EXOPHTHALMIC GOITRE.

F. Curtis (Annals of Surgery, August, 1903) states that surgical treatment is capable of curing many cases of exophthalmic goitre which have not yielded to medicine, but has very serious dangers of its own, especially that of acute exacerbation of the symptoms known as thyroidism or thyroid poisoning, which may follow any operation in these patients, whether the operation be performed on the thyroid gland itself or on other parts of the body. Exophthalmic goitre, it is held, can be cured both by thyroidectomy and by sympathectomy, or the removal of some or all of the sympathetic ganglia in the neck. A perfect result, the author asserts, can be expected in about sixty per cent of the cases of thyroidectomy. An immediately good result appears to be the rule in sympathectomy, but sufficient time has not elapsed to judge of the permanence of the cure after this operation. The relative mortality of the two methods would seem to favor sympathectomy. The author's experience of thyroidectomy has con

sisted of eleven cases, with three deaths from acute thyroidism and six cures. Of the remaining two patients one was improved and the other lost sight of. Of the operation of sympathectomy, which the author has performed in seven cases, the results have not been much better than those of thyroidectomy, as there were two deaths from acute thyroid poisoning, and a third probably due to the anesthetic. The author thinks that it is advisable to use local cocaine anesthesia for thyroidectomy, and to give this method a trial also in sympathectomy. The latter operation should, he holds, be performed on one side at a time, with an interval between the operations sufficiently prolonged to permit the patient to recover from the effects of the first.

The author considers at length the different theories that have been advanced to account for thyroid poisoning after operations for goitre. No definite conclusions are derived from this review, but it is suggested that the frequency of thyroidismus after sympathectomy, and in operations not directly involving the thyroid gland, is in favor of a nervous origin of this condition.

SARCOMATOUS TRANSFORMATION OF MYOMATA.

Myomata showing sarcomatous degeneration are, according to F. S. Cullen (Journal of the American Medical Association, Oct. 24, 1903), developed from two sources: (1) Connective tissue, leading to spindle or round-celled formation, and (2) uterine muscle. Clinically it is noted that a myomatous uterus, after being dormant for possibly several years, becomes the seat of a rapid enlargement. If the growth is submucous, portions may be expelled from time to time and there is an offensive discharge, with cachexia.

From recent laboratory investigations the following rules for operative intervention may be laid down: (1) Whenever sarcoma or carcinoma may coexist with myoma, panhysterectomy is imperative-not amputation through the cervix. (2) Bisection of the uterus is contraindicated where there is a possibility of a malignant growth developing in or associated with the myomatous uterus. (3) In every case of hysteromyomectomy it will be advisable to have an assistant open the uterus immediately on its removal to determine if carcinoma of the body exists, and to find out whether the myoma has become sarcomatous. If malignancy is detected the cervix can thus be removed without delay.

A FEW TONGUE INDICATIONS.

In a recent issue of the Chicago Medical Times the following points are brought out by the editor:

Fur upon the tongue denotes faults of the circulation and debility or inefficient action of the stomach. If it is very moist, with lack of tone, there is anemia. If the tongue be flabby or if there is tremulousness, these are evidences of marked blood impoverishment with debility, usually extreme. If the tongue be dry, a severe impression upon the nervous system, with irritability, has been made, which has suspended secretion. If dry and deep red, there is also an absence of the normal acids, and these supplied often correct a long train of symptoms.

If bright-red, raw, or glazed, there is paralysis of the sympathetic and great loss of strength-great weakness and prostration. With these symptoms the digestive apparatus is inoperative usually. If the tongue is brown, or brownish-black, with a dry, brown coat, nervous and muscular prostration are extreme and death is imminent. These conditions must be treated with acids and nux vomica, and easily absorbed predigested nourishment. The blood is broken down with these symptoms also. If darkbrown or black there is septic absorption more or less extensive, and general antiseptic treatment is demanded.

A white tongue with pale membranes indicates an excess of acids and demands alkaline medication. If with the above appearance there is a yellowish coat at the base or in the center, there is hepatic irritation with the acidity.

If the coating is white and thick, or yellowish-white and thick, with loss of appetite and depression, there is venous congestion with great inactivity of the entire digestive tract. There is lack of tone and general suspension of activity of the glandular structure of the digestive tract. This may be aroused by first thoroughly evacuating the stomach and bowels, and by giving local and general tonics.

With fissures in the tongue there is usually constipation.

If the tongue is blue or inclined to a purple tint, there is deficiency of aeration of the blood, a deficiency of red blood-corpuscles, and impairment of the general circulation.

The serious tongue indications are the very dry, thin, pointed, dark-red tongue; the sleek, glazed, red tongue; the blue tongue; the black or dark purple tongue; and the tremulous tongue.