A TEXT-BOOK OF Legal MediciNE.- By Frank Winthrop Draper, A. M., M. D., Professor of Legal Medicine in Harvard University; Medical Examiner for the County of Suffolk, Massachusetts. Octavo volume of 573 pages, fully illustrated. Philadelphia, New York, London: W. B.

Saunders & Company, 1905. Cloth, $4.00 net.

The subject of Legal Medicine is one of great importance, especially to the general practitioner, for it is to him that calls to attend cases which may prove to be medico-legal in character most frequently come. Dr. Draper has written his work both for the general practitioner and for the medical student. He has not only cited illustrative cases from standard treatises on forensic medicine, but these he has supplemented with details from his own exceptionally full experience—an experience gained during his service as Medical Examiner for the City of Boston for the past twenty-six years. During this time his investigations have comprised nearly eight thousand deaths under a suspicion of violence. The author's long teaching career has enabled him to state facts and detail procedures with a clearness rarely met in a work on Legal Medicine. Withal, we think Dr. Draper's book is unusually satisfactory; it is more, it surpasses our expectations.

THE INFLUENCE of Growth on Congenital and Acquired Deformities.— By A. B. Judson, A. M., M. D., Orthopedic Surgeon to the Out-Patient Department, New York Hospital; Ex-President of the American Orthopedic Association; formerly Surgeon, U. S N., etc., etc. 8vo., cloth, profusely illustrated, 276 pages. Price, $2.00, net. Wm. Wood & Co., Publishers, New York, 1905.

In this valuable treatise the author endeavors rather to aid and assist nature, believing, correctly, that prevention and cure are to be found in so managing a case and equipping a patient that natural growth will be the principal factor in recovery. The methods of diagnosis, prevention, and treatment are presented as having proved useful, and as apt to be suggestive and helpful in the practice of Orthopedic Surgery. The entire work is eminently practical, and we can most heartily commend it to all engaged in Orthopedic work.

Selections.

SUGGESTIONS FOR THE TREATMENT OF APPENDICITIS. Dr. A. J. Ochsner, of Chicago, whose experience with appendicitis. is probably larger than that of any other surgeon in this country, read before the Michigan State Medical Society at its annual meeting in Grand Rapids, May 26, 1904, an exceedingly valuable paper on appendicitis, in which he gave an excellent and most suggestive summary of his method of dealing with this increasingly frequent malady. We quote as follows from the Journal of the Michigan State Medical Society:

"1. The mortality in appendicitis results from the extension of infection from the appendix to the peritoneum, or from metastatic infection from the source.

"2. This extension can be prevented by removing the appendix while the infectious material is still confined to this organ. "3. The distribution or extension of the infection is accomplished by the peristaltic action of the small intestines.

4. It is also accomplished by operation after the infectious material has extended beyond the appendix and before it has become circumscribed.

"5. Peristalsis of the small intestines can be inhibited by prohibiting the use of every form of nourishment and cathartics by mouth, and by employing gastric lavage in order to remove any food substances or mucus from the stomach.

"6. The patient can be safely nourished during the necessary period of time by means of nutrient enemata. Large enemata should never be given, for they may cause the rupture of an abscess into the peritoneal cavity.

"7. In case neither food nor cathartics are given from the beginning of the attack of acute appendicitis, and gastric lavage is employed, the mortality is reduced to an extremely low percentage.

"8. In cases which have received some form of food and cathartics during the early portion of the attack, and are consequently suffering from a beginning diffuse peritonitis, when they come under treatment, the mortality will still be less than

four per cent., if peristalsis is inhibited by the use of gastric lavage and the absolute prohibition of all forms of nourishment and cathartics by mouth.

"9. In this manner very dangerous cases of acute appendicitis may be changed into relatively harmless cases of chronic appendicitis.

"10. In my personal experience no case of acute appendicitis has died in which absolutely no food of any kind and no cathartics were given by mouth from the beginning of the attack. "II. The mortality following operations for chronic appendicitis is exceedingly low.

"12. Were peristalsis inhibited in every case of acute appendicitis by the methods above stated, absolute prohibition of food and cathartics by mouth and the use of gastric lavage, appendectomy during any portion of the attack could be accomplished with much greater ease to the operator and correspondingly greater safety to the patient.

"I would make the following suggestions for the treatment of appendicitis with a view of reducing the mortality:

"1. Patients suffering from chronic recurrent appendicitis should be operated on during the interval.

"2. Patients suffering from acute appendicitis should be operated on as soon as the diagnosis is made, provided they come under treatment while the infectious material is still confined to the appendix, if a competent surgeon is available.

"3. Aside from insuring a low mortality, this will prevent all serious complications.

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4. In all cases of acute appendicitis, without regard to the treatment contemplated, the administration of food and cathartics by mouth should be absolutely prohibited, and large enemata should never be given.

"5. In case of nausea or vomiting or gaseous distension of the abdomen, gastric lavage should be employed.

"6. In cases coming under treatment after the infection has extended beyond the tissues of the appendix, especially in the presence of beginning diffuse peritonitis, conclusions 4 and 5 should always be employed until the patient's condition makes operative interference safe.

"7. In case no operation is performed, neither nourishment nor cathartics should be given by mouth until the patient has been free from pain and otherwise normal for at least four days.

"8. During the beginning of this treatment not even water should be given by mouth, the thirst being quenched by rinsing the mouth with cold water and by the use of small enemata. Later, small sips of very hot water frequently repeated may be given, and still later small sips of cold water. There is danger in giving water too freely, and there is great danger in the use of large enemata.

“9. All practitioners of medicine and surgery, as well as the general public, should be impressed with the importance of prohibiting the use of cathartics and food by mouth, as well as the use of large enemata, in cases suffering from acute appendicitis.

"10. It should be constantly borne in mind that even the slightest amount of liquid food of any kind given by mouth may give rise to dangerous peristalsis.

"II. The most convenient form of rectal feeding consists in the use of one ounce of one of the various concentrated liquid predigested foods on the market dissolved in three ounces of warm normal salt solution introduced slowly through a soft catheter, inserted into the rectum a distance of two to three inches.

"12. This form of treatment cannot supplant the operative treatment of acute appendicitis, but it can and should be used to reduce the mortality by changing the class of cases in which the mortality is greatest into another class in which the mortality is very small after operation.

"In employing rectal feeding, it is important to follow a definite plan, which an experience with a very large number of cases has demonstrated to give the best results with the least amount of annoyance to the patient.

"It has been found that any one of a number of reliable liquid predigested foods in the market is much better than a mixture. of egg and various other foods which are frequently employed. The quantity should be small. Usually an ounce of predigested food, dissolved in three ounces of normal salt solution, is most

readily borne by the patient. It is usually best to give this every four hours, and if the patient is suffering from thirst, an enema of from eight to sixteen ounces of normal salt solution may be given half way between feeding until the thirst has subsided.

"A soft rubber catheter, No. 8, English, should be attached to a funnel or to an ordinary one-ounce glass syringe. It should then be thoroughly lubricated with oil or vaseline, and inserted into the rectum not more than two to three inches. Then the food should be poured into this funnel or syringe, and should be permitted to enter the rectum by its own weight. Many patients who are greatly disturbed if the food is forced into the rectum with a syringe, can be fed by the method just described, with perfect comfort. In case, however, the patient retains the nourishment temporarily, the rectal feeding is interrupted for twelve to twenty-four hours."- Modern Medicine.

CHOICE OF A GENERAL ANESTHETIC; AND SELECTION OF METHOD OF ADMINISTRATION.-V. C. Pedersen succinctly discusses the question of general anesthesia, both in respect to the qualities of the several agents and anesthetic sequences used, and in regard to the method best suited for various types of cases. In the selection of anesthetics for routine use, it is recognized that nitrous oxide is the safest known anesthetic, especially when administered with oxygen. Ethyl chloride promises rivalry in this connection, but its employment is too recent to warrant a fixed statement at the present time. Ether is the next safest, and perhaps when the length and severity of ether operations is compared with that of operations suitable for the preceding two agents, ether is the safest of all. Ether has many advantages over chloroform, and is five times safer. The various mixtures of chloroform and ether, in point of safety, occupy a middle place between the two drugs themselves, the relative danger being greater the higher the percentage of chloroform. The conditions covering the selection of anesthetics for particular patients are discussed under eleven heads so concisely as not to permit of abstract. Medical Record, February 11, 1905.