Nothing goes unmentioned, but the discussion of rare complaints is wisely left out. Numerous illustrations are given to demonstrate operative measures and instruments, and the book closes with a very excellent chapter on ocular therapeutics and general rules for eye operations.

We can highly recommend the manual as a very readable book and as a valuable addition to any medical library, but particularly to that of a student, house-surgeon or a general practitioner.

CLINICAL TREATISES ON THE SYMPTOMATOLOGY AND DIAGNOSIS OF DISORDERS OF RESPIRATION AND CIRCULATION. By Prof. Edmund von Neusser, M.D., Professor of the Second Medical Clinic, Vienna; Associate Editor, Nothnagle's "Practice of Medicine." Authorized English translation by Andrew MacFarlane, M.D., Professor of Medical Jurisprudence and Physical Diagnosis, Albany Medical College; Attending Physician to St. Peter's and Child's Hospital and Albany Hospital for Incurables. Part I., Dyspnea and Cyanosis, Oct., 200 pp., cloth, $1.50; ready September. Part II., Angina Pectoris, in press. Part III., Tachycardia and Bradycardia, in press. New York: E. B. Treat & Co., publishers, 241-243 West 23rd Street.

'GREEN'S ENCYCLOPEDIA AND DICTIONARY OF MEDICINE AND SURGERY. Vol. V. Inulir to Lumbar-Puncture. Edinburgh and London: William Green and Sons. With this volume the completion of the first half of the work is accomplished, and the high standard set in the earlier numbers is fully kept up. There has been practically no change in the general outlines adhered to in the former volumes. The subject-headings number over nine hundred. Among the more prominent articles we note especially those dealing with diseases of joints, the kidneys, liver, and of greatest length is that devoted to labor, which claims over one hundred and fifty pages, illustrated by numerous plates and diagrams. It fully takes up physiology, mechanism, diagnosis, the various accidents, operations in use, and finally the hemorrhages encountered. A considerable section dealing with the larynx and its diseases is well worthy of the specialist's attention, and to those interested in dietetics ample matter is provided, with dietaries, recipes, etc., occupying a prominent part.

A Clinical Study of 293 Cases of Pulmonary Tuberculosis.

In a comprehensive article, comprising a clinical study of 293 cases of pulmonary tuberculosis treated at the Winyah Sanitarium, Asheville, N.C., in 1905 and 1906, Karl von Ruck and Silvio von Ruck, of Asheville, N.C., speak well of the results they have obtained with the watery extract of tubercle bacilli in the various stages of the disease. Other drugs were but rarely employed, but styracol (guaiacol cinnamic ester) gave satisfaction. The following remarks are thus made concerning tuberculous affection of the intestines. In sixteen cases the clinical symptoms were sufficiently marked, even if tubercle bacilli had not been demonstrated in the feces, to leave little if any doubt of the presence of ulceration. In nine of the cases the symptoms subsided, and there was no return on the resumption of an ordinary diet. In four cases the symptoms were much improved, while in three cases they could be only more or less controlled. In these cases opium with lead acetate appeared most serviceable in checking the diarrhea, the addition of the lead salt bringing striking benefit. The much better results in the present cases, as compared with the cases of the authors' last report, may, of course, be matter of coincidence, and they fully appreciate that so small a number of cases does not justify conclusions of the therapeutic value of remedies employed, but they are nevertheless of the opinion that the use of styracol in large doses and for prolonged periods was of material aid in the treatment of this most undesirable complication of the cases discharged, as also in a number of others still under treatment.

Diarrhea was noted in six cases, apparently of non-tuberculous origin and of indeterminate immediate cause, except in one case, in which amyloid of the intestine was suspected and eventually confirmed.

In the other five patients the diarrhea has existed for periods of several months to a year prior to coming under the authors' care. The stools were found liquid, evacuations occurred from two to six times a day, unattended by pain or tenesmus; the feces contained more or less undigested food remnants, especially meat fibers; there was neither pus nor mucus to suggest ulceration or catarrh. Under dietetic regimen some improvement was noted. The administration of digestive ferments and acids, astringents, or bismuth had apparently no influ

ence, but the use of styracol seemed to render valuable aid. In two cases complete cure was obtained under its use; two cases were greatly improved; in one case in which styracol was not prescribed the diarrhea could be controlled only with opiates (paregoric).-From Report from Winyah Sanitarium. Increasing Usefulness of Ichthyol.

Ichthyol possesses a widening range of useful application, comments R. B. McCall, of Hamersville, O. Erysipelas promptly yields to its influence; heat, redness, and tumefaction rapidly giving place to normal conditions. The affected area must be entirely covered and the surrounding healthy skin as well, for one inch or more, with the undiluted remedy. When the violence of the attack has somewhat abated, a dilution may be applied by means of cloths, which are to be constantly renewed. Anginose attacks, as pharyngitis or tonsillitis, when there is bright redness of the mucous surfaces, are greatly benefited by ichthyol gargles. In inflamed articulations of rheumatism and rheumatoid arthritis it must be thickly spread over the joint and covered in with cotton wool. Small joints of the hands and feet are very tender and painful in rheumatoid arthritis, therefore they should early be thickly covered by layers spread one upon the other.

A use of ichthyol that perhaps best illustrates its peculiar power and efficacy is found in the treatment of carbuncle. No fear of overstating the truth when it is asserted that it is superior to all other known medicaments for the purpose. One need only to employ it in a few cases to prove its surpassing promptness and effectiveness. Uniformly spread over the carbunculous mass and beyond its base, leaving only the apex uncovered, its influence is seen almost at once in disorganization. Usually in twenty-four or thirty-six hours free discharge takes place, with satisfactory relief of all the symptoms. This is stated as a rule, to which there are exceptions, perhaps one in five or six that will require longer time. A few years ago, after demonstrating to his entire satisfaction its great efficacy in this disease, the author first published an account of his findings. Ellingwood's Therapeutist, April, 1907.

Various Forms of Uterine Hemorrhage Treated with Stypticin.

M. Nigoul finds in stypticin an agent as valuable in controlling hemorrhage from the uterus and adnexa as are ergot or hydrastis-if not more valuable. By reason of its chemical

constancy, moreover, the action of stypticin is uniform and it has a mild, analgesic action. The author has made a series of observations on its use in the treatment of various groups of gynecological affections. In the first group he classes the menorrhagias and metrorrhagias of young menstruating girls, as well as the dysmenorrheas. In these cases 5 to 6 tablets of 34 grn. each are given daily until the pain and bleeding have markedly diminished. From 3 to 4 tablets a day have proven serviceable in preventing attacks. Stypticin is particularly indicated in the bleeding at the climacteric period. Nigoul administered 3 to 5 tablets a day for ten days, and repeated the treatment after a week's pause, with the result of greatly lessening the flow and the pain, and bringing about a more rapid completion of the period of the menopause.

In a second group of metritis and displacements, stypticia proved very effective. In metritis fungosa it has a marked hemostatic action, especially following curettage.

For the hemorrhage of parenchymatous metritis and the bleeding of child-birth, its hemostatic action is prompt and efficient. Three to four tablets after the beginning of menstruation in retroversions, associated with neuralgic pain and profuse menorrhagia, have cured. In hematosalpinx and catarrhal salpingitis he reports some striking results, particularly in a case of tubal hemorrhage in a thirty-seven-year-old woman. The administration of 6 tablets was followed by a marked reduction in the hemorrhage.-Aerztl. Mitteilungen, 1907, No. 5.

Appendicitis in Infants and Children.

Dr. Erdman states that the diagnosis of appendicitis is more difficult in children than in adults, owing to the lack of a good history and the presence of gastro-intestinal complications. He disregards the eating of meat as a cause of appendicitis, because he has found the disease occurring frequently in milkeating infants. The appendix has not assumed its normal position until the third or fourth year and is often found under the costal arch, so that the point of pain and tumor is much higher than in the adult. The gastro-intestinal symptoms are vomiting, elevation of temperature, and tenderness. Fecal concretions and pinworms have been found by the author in the appendix of children. He is a firm believer in early operation. The bowels should move the day after operation, and the patient is allowed to roll and sit up in bed after the third day.-Medical Record.

Calcium Chloride.

Arnold Netter reports in Le Bulletin Médical that while so far no method has been found to prevent the appearance of the urticarial eruption after the injection of a dose of serum, he has found that the use of calcium chloride in the dose of one gram a day on the day of injection and for two days following constituted an efficient prophylactic in a large proportion of the cases. Out of 252 patients who took the remedy as directed there were only a little over 2 per cent. of eruptions, while in 258 cases not receiving it the eruptions were over 15 per cent. The use of calcium chloride does not in any way impair the action of the diphtheria antitoxin, the mortality in the two groups being nearly the same. Instead of the calcium chloride may be used the lactate, which has no taste and is also very soluble.-Wisconsin Medical Record.

Ethyl Chloride as an Anesthetic,

Like chloroform ethyl chloride paralyzes the heart-muscle; but it requires nineteen times as much ethyl chloride vapor as chloroform vapor to produce similar results. Like chloroform, ethyl chloride relaxes the arterioles, but the amount required to do it is greater than that of chloroform. Ethyl chloride stimulates the central vasomotor mechanism. When the vapor is present in the air in the proportion of 10 per cent., vagus inhibition of the heart readily occurs, resulting in sudden fall of pressure. When the amount of vapor in the inspired air reaches 30 per cent., the sudden fall of pressure is also due to weakening of the cardiac and arterial musculature. The cardiac inhibition due to ethyl chloride is not so serious as that from chloroform, however, because it appears before the spontaneous excitability of the heart is much depressed. It does not seem possible to arrest the sound heart of a dog permanently under ethyl chloride narcosis by vagus inhibition. It requires nineteen times as much ethyl chloride as chloroform to produce a given degree of cardiac depression, while it requires only four times as much to produce cardiac arrest by vagus stimulation; hence inhibition sets in with relative rapidity. Herein lies the comparative safety of ethyl chloride. The cardiac inhibition arises from central stimulation; it is not reflex. There is no evidence of paralysis of vagus endings. In ethyl chloride narcosis the integrity of the respiratory mechanism is dependent upon the maintenance of blood-pres

sure.

In the administration of ethyl chloride vapor for anes