A TREATISE ON THE SCIENCE AND PRACTICE OF MIDWIFERY. By W. S. Playfair, M.D., LL.D., F.R.C.P., Physician-Accoucheur to H. I. and R. H. the Duchess of Edinburgh; Professor of Obstetric Medicine in King's College, Etc., Etc. Fifth American from the Seventh English Edition. With Notes and Additions by Robert P. Harris, M. D., with 5 Plates and 207 Illustrations. Philadelphia: Lea Brothers & Co. Price, sheep, $5.00; cloth, $4.00.

Playfair's Midwifery is one of the standard works, and is so well and favorably known to the profession that we shall simply give a synopsis of the improvements that have necessarily been made in this edition, as four years have elapsed since the last American edition was issued. The most notable changes have taken place in the Porro-Cæsarean operation, the conservative Cæsarean operation, and the exsective method of treating extra-uterine pregnancy where the foetus is alive and of viable development. Dr. Harris has completely Americanized this edition upon the points where English and American obstetricians differin opinion and practice, to fit it for the uses of American medical students and obstetricians. We highly commend this work to our friends.

THE STORY OF THE BACTERIA, and their Relations to Health and Diseases. By T. Mitchell Prudden, M. D. New York and London: G. P. Putnam's Sons, Price 75 cents.

This brochure gives in plain language a collation of facts in regard to bacteria. So much has been said in regard to these small forms of life, which are misleading, that Dr. Prudden has wisely given, to all who wish to study them more thoroughly, a small work that can be readily understood. It will be well for you to secure a copy and read up on this subject.

SURGERY, ITS PRINCIPLES AND PRACTICE. BY T. Holmes, M. A. Cantab., Consulting Surgeon to St. George's Hospital, Member Associé de la Soc. de Chir. de Paris. With 428 Illustrations. Fifth Edition. Edited by T. Pickering Pick, Surgeon to and Lecturer on Surgery at St. George's Hospital; Senior Surgeon Victoria Hospital for Children; Member of the Court of Examiners Royal College of Surgeons, England. Philadelphia: Lea Brothers & Co.

A work that has for its author such a well known man as Dr. Holmes must necessarily fill the wants of all who wish a work of this nature. This edition brings the subject matter up to the latest and most

approved methods known in surgery. The operative treatment in reference to cerebral localization has also been discussed, as far as our present knowledge of the subject permits. Among the subjects that have been specially revised are those on Inflammation, Wounds and their Treatment, Tumors, Diseases of the Bones and Joints, Abdominal Surgery, and Intestinal Obstruction. We strongly recommend this work to our readers as alike indispensable to both physician and surgeon. THE PHYSICIAN'S POCKET DAY-BOOK AND LEDGER. A Unique and Systematic Method for Physicians to keep a condensed and accurate Record of Accounts, which may be posted at a glance. Los Angeles, Cal.: W. W. Hitchcock, M. D. Price $2.00; with name, $2.50.

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THE NERVO-VASCULAR SYSTEM. Arranged by W. Henry Price and S. Potts Eagleton. Examined and Approved by John B. Deaver, M. D., Demonstrator of Anatomy, Univ. of Pennsylvania. Philadelphia: F. A. Davis, Publisher. Price per set, 50 cents.

This is composed of three charts: Part I, The Nerves. II, The Arteries, III, The Veins. We take pleasure in calling attention to these charts as they are so arranged that a study of them will serve to impress them more indellibly on your mind than can be gained in any other way. They are also valuable for refer

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Vol. III, No. 3, contains papers on the following subjects: "Congestive Neurasthenia or Nerve Depression"; "The Art of Embalming"; "The Etiology, Diagnosis and Treatment of Tuberculosis"; "Psycho-Therapeutics or Treatment by Hypnotism"; "Sexual Activity and the Critical Period in Man and Woman."

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Diagnosis and Treatment of Fracture of the Neck of the Thigh-bone.* Years ago, fracture of the neck of the thigh-bone was classified into intra-capsular and extra-capsular fractures, that is, in the narrow portion of the neck within the capsular ligament, and at the base of the neck against the trochanter major and outside the capsular ligament.

A more practical classification consists in distinguishing between impacted and unimpacted fracture of the neck of the thigh-bone.

Diagnostic Points of Fracture of the Neck of the Thigh-bone. -It occurs in subjects past the prime of life, that is, between fifty years and upwards. Fractures within the capsular ligament are most frequent in old women, in old men the base of the neck is most commonly the seat of fracture.

It is caused by slight violence, thus, a fall on the hip striking the trochanter, muscular contraction, as when an old person makes a misstep, the violent muscular contraction of the body to save from falling concentrates the force of contractile movements on the muscles that pass from the pelvis to the thigh-bone

Excerpt from a forth-coming work on fractures and dislocations.

No. 12.

thus snapping the bone in the neck; the fall is a secondary result in consequence of the fracture more than a cause of it. The neck of the bone may be broken by simply catching the toes in the carpet, etc., the sudden twist of the body while the foot is stationary, causes the bone to break. All these are trivial causes, yet the most frequent, hence we are forced to the conclusion that this fracture is essentially confined to the senile state of life.

Loss of Function.-As the patient lays on the bed it is noted the injured limb is peculiarly helpless, it is rolled outward, the toes are averted. When the patient is told to lift his foot from the bed, he attempts it by slowly dragging the foot toward the pelvis by bending the knee, he may use his hands to assist the movement, but he is unable to raise the foot up above the bed. The whole limb has a helpless appearance.

nute the trochanter major the fragments are loosened and separated so that shortening is considerable from the outset. The fragments may be unimpacted by the imprudent manipulations of the surgeon in his unwise zeal in endeavoring to make a diagnosis by violent extension and rotation of the limb, there are better ways of diagnosis, which will be set forth directly.

Pain. The pain is peculiarly sharp in the groin when the limb is adducted, especially when the fracture is in the narrow part of the neck. While the limb lies quiet, there is but little pain complained of. When the base of the neck is the seat of the fracture and the trochanter much split, pressure over these parts cause much pain, so does abduction of the limb. In most cases the trochanter has a peculiarly depressed appearance as if stove in and crushed. When the comminution of the trochanter is considerable, this prominence appears full and large though stove in.

Crepitation-Is only present when the trochanter is much comminuted. When the shortening is considerable there is no crepitus, because the fragments have slipped by. At best, crepitation is not to be sought for very zealously for reason of the damage it may do by unimpacting the fragments.

When the limb is rotated the trochanter moves in a smaller circle than on the sound side.

Diagnosis from Scarpa's Space.-In the normal state of the neck of the thigh bone, i.e., when not fractured, the fingers can be pressed deeply into scarpa's space, but when the neck of the thighbone is fractured a bony-like tumor is felt just outside the femoral vessels, when the fingers are pressed in this space. This is a fairly good diagnostic point and is pierced an inch or two below Poupart's ligament, over which pressure is painful.

Another pretty fairly reliable sign of this fracture is the peculiarly relaxed state of the fascia lata of the thigh as contrasted with the other side. Diagnosis by Measurement. Any shortening in the length of the thighbone, caused by fracture of the neck, can be made out by measuring from the tip of the trochanter major to the crest of the

ilium. A more correct measurement may be made by dropping an imaginary plumb line from the anterior superior spine of the ilium to the floor as the patient lies on his back. By noting in the mind's eye where the plumb line will cut pelvis on both sides, and then measuring from the tip of the trochanter major on each side to this imaginary line, any dif ference in length between the two sides will indicate a fracture of the neck of the femur on the injured side.

Dislocations of the head of the thighbone backward are easily eliminated by noting the signs we have given in the diagram of differential diagnosis of frac ture and dislocation of the hip joint.*

TREATMENT. - The main practical points of treatment are- to secure immobilization of the fragments as near as can be safely undertaken, prevent bed sores, inflammation of the joint, and to sustain the strength and promote the comfort of the patient while the treatment is in progress. Old people illy bear confinement, especially the kind necessarily enforced during treatment of fracture of the femur. We have to combat the liability to bed sores, exhaustion of the nervous system by pain, dyspepsia, confinement, etc., and arthritis, a serious annoyance often encountered.

Spasms of the muscles which produce extreme pain and exhaust the nervous energies, are the result of movements of the fragments, which irritate the soft structure and produce spasms. Immobilization is intended to prevent these as well as additional shortening.

The Bed-Should be firm and solid and as comfortable as the nature of the circumstances will admit. A firm mattress is to be used when it is at hand. The worst bed is of feathers or a thick cotton mattress that allows the hips to sink. In the absence of a solid mattress, quilts and comforts can be used, folded and laid on the bedstead bottom. Avoid wire bed bottoms, they let the hips sink. It is best to lay boards lengthwise of the bedstead, long enough to extend a foot or two beyond the foot rail, cut out the foot board of the bedstead and nail a piece of

This diagram will be printed in the book, also we have prepared it in the form of a chart for framing. Price €0 cents.

of

board on the under side of the long rails to secure stability to the bedstead. On these boards the bed is made. Cover the bed with a rubber cloth, three or four feet wide and as long as the width of the bed, this is to be placed where the hips and lower part of the back and upon part of the thighs if the patient will rest. Next cover the bed with two sheets folded separately lengthwise, meeting in the center. The object is to admit changing the sheets without much disturbance of the body of the patient, his body can gently be turned to one side while one section of the sheet is removed and a clean one placed in its stead. In this way the bed and its clothing can be kept clean. A bed-pan can be conveniently slipped under the nates of the patient when the calls of nature require attention.

Careful measurement will indicate the amount of shortening. In fractures of the neck within the capsule, shortening may at first be very slight, hardly half an inch or even less when the fibrous structures are not lacerated, the displacement of the fragments being trivial. In these cases the amount of extension with weights should only be sufficient to produce immobilization of the limb,and prevent any further shortening rather than to overcome that which is present. This is an important practical point to bear in mind, for attempts and efforts to overcome the slight shortening only serve to unlock the fragments if they are impacted, or displace them when they are in apposition. It must be also borne in mind only the most gentle and least disturbing measures should be adopted to make a diagnosis, that the objective symptoms, when well weighed, and careful measurements, are sufficient for diagnosis without resort to efforts to obtain crepitus, which are sure to do damage by tearing the fibrous structures that are still untorn, or only slightly, and separate the fragments, thus converting a case favorably conditioned for recovery into an unfavorable and unpromising one.

In fractures of the base of the neck that are impacted there is not much shortening and the trochanter moves with the shaft of the bone when it is rotated. Extension by weights and the long splint to secure immobilization of the limb are

adopted. The amount of weight is only sufficient (as in the previous class of cases) to prevent more shortening and not to overcome that which is already present.

The long straight splint is to be used. It must extend from a little below the axilla to eight inches below the foot, its width is about four or five inches, and in thickness one-half or three quarters. This splint is to be well padded, an old quilt folded to the proper width and thickness is used and retained to it by a bandage four inches wide applied the whole length, this secures the pad finely and also gives a surface outside for pinning, retaining pieces of bandage to that which encircle the limb and splint. The splint being prepared is set aside for the present.

The extension strip of adhesive plaster is about fifty-six to sixty inches long and four or five inches wide. It is applied to the inside and outside of the thigh and leg, one end is applied to the thigh onethird above the knee, on the outside, then extends down the outside of the leg; the other end is applied on the inside of the thigh and leg in the same way; the middle forms a loop in front of the sole of the foot. In the loop a piece of wood (the "stretcher ") three inches wide and half an inch longer than the width between the two malleoli, in the center of it a hole is bored to admit a stout cord knotted securely at the end to prevent it being pulled through the hole, to the other end of the cord is attached the extending weight. To assist in securely keeping this extension strip of plaster in place, a few turns of a roller bandage are applied to it above and below the knee and about the calf of the leg; the

stretcher" in the loop prevents the plaster pressing on and chafing the ankles; these latter had better be covered with pieces of patent lint to insure their protection, every care being taken to prevent them getting sore, otherwise much trouble and inconvenience will be encountered in carrying out the treatment successfully.

Application of the Splint.-This is applied on the outside of the limb and body, the padded side turned to the skin. The upper end is secured to the body by a wide strip of stout cotton sheeting which encircles the body and embraces the