cess as on a neuralgia of the ovary. "In the latter instance castration will prove just as effective as removal of a tooth in case of trigeminal neuralgia.' 5, Diseases of the nervous system which stand in close relation with the sexual functions. This indication is the one which is most liable to abuse. Our knowledge of the diseases of the nervous system is as yet too imperfect to allow us to formulate the etiological connection between such diseases and the ovary. In this connection Olshausen again records himself as being in disaccord with Hegar, who is inclined to resort to oöphorectomy very often in such cases. It will be seen, indeed, that Olshausen, whilst no pessimist in regard to this operation, would limit the indications within very narrow bounds, and in this respect he is in full accord with the majority of American operators. He has himself performed the operation only twenty-one times, and thirteen of this number were cases of uterine myoma; his mortality rate of nineteen per cent occurring entirely in this latter series of cases.

Prof. Bandl's article is decidedly the most interesting in this volume, dealing, as it does, with those diseases of the female generative organs which are the special theme of discussion today. There is no subject of greater importance to the practitioner than pathological alterations in the tubes. The difficulties in the way of correct diagnosis are great; and the diagnosis once reached, the question of treatment is vital to the interest of woman. It is our belief that there has been entirely too much surgery in this direction, and too little reliance on medical methods. The pendulum, however, is beginning to swing towards the side of conservatism, and the day is not far distant when fewer tubes will be removed, and these in the presence of something more definite than local pain and bogginess. The crucial indications for removal of the tubes should be evident distention of these organs, accompanied by pain which makes life unendurable, or these symptoms accompanied by recurrent attacks of peritonitis. Unquestionably such are the signs which ordinarily have impelled the majority of surgeons to laparotomy, but unquestionably also the operation has been abused by lesser lights in the face of indications less urgent, where appropriate local treatment, in particular the galvanic current, might have resulted in cure. In these pages the student will find a very complete account of tubal diseases and their diagnosis, as well as ample conservatism in the views expressed in regard to operation. The operation is stated to be much more difficult and far more dangerous than the ordinary ovariotomy, the greater danger being evidenced by the fact that in the practice of A. Martin five deaths in eighteen cases occurred, and four of these from sepsis. An impartial estimate of the danger, as deduced from a study of the results obtained by leading English and American operators, would lead us to think that this is hardly in excess of that following on ovariotomy.

Passing to the subject of extrauterine pregnancy, Bandl's article has become classic, and calls for but little notice at our hands. Under the head of the abdominal variety, we would lay renewed stress on the value of the absence of intermittent uterine contractions as an aid in diagnosis. We would make the general criticism that Bandl would have added to the value of this portion of his contribution, had he utilized for this edition papers which have appeared since the publication of the first. For instance, under the head of etiology, he repeats the assertion that ectopic gestation is rare,

since Braun and Spaeth found only five cases in sixty thousand patients; and yet Garrigues has shown us that the condition is far more frequent; and again, when speaking of the treatment of tubal pregnancy, it is inexcusable for him to dismiss in a few lines the method of all others which has given the best results, and never, we believe, a failure-electricity. That this method has never been tried in Europe is no proof that it is worthless, but rather, in face of the facts, it is proof of mental obliquity. Further still, it would not have been improper to state that laparotomy in case of rupture of the cyst was suggested long ago by an American, Stephen Rogers, that another American, Thomas, has long been in favor of the procedure, and that still another American, Briddon, resorted to it. Evidently, we must blow our own trumpet where our German brethren are concerned! We are pleased to find Bandl condemn puncture of the sac, as well as, less emphatically it is true, the injection of narcotics. Since then Bandl does not favor these latter methods, and cannot, from what he hears of electricity on this side of the water, be induced to try it, the only method of treatment remaining is extirpation of the sac, and this he advocates wherever the diagnosis is certain. Lawson Tait has recently expressed the same opinion. It is safe to say, however, that Americans will choose the safer and just as radical methodthe application of faradism or galvanism. In case of abdominal gestation, Bandl very correctly lays stress on the statement that, in the choice of operation, laparotomy should take precedence over vaginotomy whenever the greater part of the sac or of the fetus lies above the pelvic brim. After the death of the fetus, instead of the counsel to wait for symptoms before resorting to laparotomy, in face of the high mortality rate which follows expectancy, Bandl would favor earlier resort to operation, in which respect Lusk has very recently similarly recorded himself.

The second part of Bandl's contribution concerns the diseases of the ligaments, pelvic peritoneum, and cellular tissue. He makes a sharp distinction between cellulitis and peritonitis, in accordance indeed with the belief entertained by the majority of gynecologists up to very recent date. There can be no question, however, but that this entire subject will have to be rewritten in the light of the knowledge acquired from laparotomies. Cellulitis is with us less frequently diagnosticated than it was a few years ago, and in its place we recognize that we are in reality dealing with a peritonitis-the result of tubal or ovarian disease. As an etiological cause of peri- and parametritis Bandl considers gonorrhea the most frequent. In speaking of the treatment of the manifold reflex and psychical disturbances which have their outcome from chronic inflammatory remnants, the following sentence deserves emphasis: "Although we may remove ovaries and tubes and portions of the broad ligaments, yet there may remain indurations in the cellular tissue, which, through compression of nerves, will cause the identical symptoms for the relief of which we had resorted to operation." Such is the secret of the symptoms still complained of by many a patient who has been subjected to, but but not benefited by, laparotomy.

This contribution concludes with a very satisfactory account of hematocele and hematoma. An excellent feature of the contribution are the numerous woodcuts, especially in connection with tubal diseases, which illustrate the text. By mistake of the printer, the pages numbered from 235 to 250 inclusive are duplicated, and

we note an occasional error in the spelling of proper namesLoveing for Lovering, Landes for Landis, and Mathews Duncan for Matthews Duncan.

EGBERT H. GRANDIN.

DISEASES OF THE DIGESTIVE ORGANS IN INFANCY AND CHILDHOOD, with chapters on the Investigation of Disease, and on the General Management of Children. By LOUIS STARR, M.D., Clinical Professor of Diseases of Children in the Hospital of the University of Pennsylvania; Physician to the Children's Hospital, Philadelphia, etc. With lithographic plate and other illustrations. Pp. 355. P. Blakiston, Son & Co., Philadelphia, 1886.

Wisely beginning with a chapter on the investigation of disease, the work successively treats of the affections of the mouth and throat; of the stomach and intestines; of caseous degeneration and tuberculosis of the mesenteric glands; of affections of the liver and of the peritoneum; concluding with a section on the general management of children. It is the author's intention "to give prominence to a class of disorders constituting a large proportion of the ailments of childhood, but often too briefly considered in works on pediatrics."

Considering that, for the successful treatment of the disease of the digestive organs in infancy and childhood, "attention to the general regimen is quite as important as the administration of drugs," more attention is paid to hygiene and dietetics than to medicinal measures; this, however, without neglecting any important point. Clear and fresh in style, with subject matter interesting and instructive, the work throughout is eminently practical, bears evidence of great painstaking and personal knowledge and experience on the part of its author, is one that will amply repay careful study, and one that should be known to every one who has occasion to treat the ailments of children.

BROOKS H. WELLS.

THE PRINCIPLES AND PRACTICE OF SURGERY. BY FRANK HASTINGS HAMILTON, A.M., M.D., LL.D., etc. Illustrated with four hundred and seventy-two engravings on wood. Third Edition, revised and corrected. New York: Wm. Wood & Co., 1886, pp. 964.

While this work stands in the front rank as one of the most reliable, concise, and conservative treatises on modern surgical procedures, a book which should be in the hands of every student and of every practitioner, and which we trust will continue to maintain its well-earned place in the profession's estimation, yet it stands in one respect a fulfilment of the prophecy of its author, as stated in the preface of the second edition, that no one man could in the future write a complete treatise on surgery. The defect lies in the chapter which it is the province of this JOURNAL to review, the forty-seven pages devoted to the consideration of gynecic surgery, and which, so far as the value of the book is concerned, had better have been omitted. So immense has been the progress of this particular branch of surgery, so radical the changes in operative methods and procedures, and so complete the reverses of professional opinion, that it is impossible for a general surgeon, one not making these operations a specialty, to decide authoritatively and correctly on the points at issue. Many of the arbitrary opinions given in this chapter have been formed, evidently, not from practical experience with the procedures de

nounced, but from preconceived notions of surgical right and wrong. Thus are the unqualified denunciations of hysterectomy, of Alexander's operation for shortening the round ligaments, and of the operation for primary perineorrhaphy.

In some other respects the chapter is behind the times; the statistics of mortality after oophorectomy are those published in 1881 and are much too high (18.72%), increased operative skill and improved methods having now reduced it greatly; no mention is made of the method of diagnosis of ovarian cysts by chemical and microscopical examination of their contents; we are advised not to include the peritoneum in our suture when closing a laparotomy wound; we are advised to excise "ovula Nabothii when simple scarification and application of tr. iodi is sufficient for a cure; in amputation of the cervix for malignant degeneration, "the neck of the womb is seized with the vulsellum, drawn outside the vulva, and removed with a strong pair of scissors or the knife," no mention being made of the important supravaginal operation, of the use of the galvano-caustic loop, or of palliative treatment by the curette or zinc chloride; after a Cesarean section done in the manner here indicated we should be much surprised if our patient recovered; it is noted that electricity has occasionally (sic!) been successfully employed in the destruction of an extrauterine fetus; Emmet's operation for lacerated cervix, its indications, and the after-treatment, is described in a dozen lines; the treatment of urinary fistula by Bozeman's method-which few besides its author use now-is well described, though entirely too much space is given to it when compared with other more important subjects which have been over-condensed and cramped.

The attempt has been made to measure the sea in a peck basket, and naturally it has failed.

BROOKS H. WELLS.

TRANSACTIONS OF THE OBSTETRICAL SOCIETY OF LONDON. Vol. XXVII., for the year 1885. Eighteen lithographic plates, thirteen woodcuts. Pp. 332. London: Longmans, Green & Co., 1886. While this volume is of interest, as showing what has been done in obstetric and gynecic work in London during the past year, it contains but few papers of any great value to American readers.

DR. MATTHEWS DUNCAN occupies more than his usual number of pages with three papers on his favorite disease, lupus (syphilis ?) of the female generative organs. These papers, which cannot be regarded as at all conclusive, treat of lupoid hypertrophy, ulceration, and inflammation, the first two being made up chiefly of case-reports, each case being illustrated by a life-size chromolithograph representing the gross appearances, but entirely omitting those minute details which would so greatly have enhanced their value; as they now stand, the conditions shown bear a very close resemblance to some of the lesions of tertiary syphilis and chancroid. Cases showing similar lesions and similar symptoms to those described in Dr. Duncan's paper, but with undoubted evidence of previous syphilitic poisoning, can be found not infrequently in the venereal wards of any of the city hospitals.

The paper on extirpation of the entire uterus, by WM. A. DunCAN, is the most valuable that the book contains. First reporting two cases of his own, where he had excised the uterus per vaginam, he then discusses the relative advantages of the vaginal and abdominal methods, the ultimatum being in favor of the former.

In a table of 137 cases of abdominal extirpation, which he had collected, there were 99 deaths (72%); while in 276 cases of vaginal extirpation there were only 79 deaths (28.6%). Then follow some remarks on various details of the procedure and on its indications and contra-indications, supra-vaginal amputation of the cervix, its results and mortality being incidentally discussed. In concluding, the author weighs the facts, pro and con., urges the paramount importance of an early examination with the curette and microscope in all cases of doubtful uterine disease, and states that where cancer can be detected in the body of the uterus, or in the mucous membrane of the cervix, then extirpation may be resorted to with reasonable prospect of prolonging life; but in all cases of cancer affecting the vaginal position of the cervix, and, à fortiori, when there is the least implication of the vaginal walls, that ablation of the uterus is an unjustifiable procedure, when we can gain nearly (261% as compared to 30%) as good results from supravaginal amputation, the immediate risks to life from which are four times less.

The discussion following the paper is valuable as showing the opinions of men like Williams, Thornton, Doran, Playfair, Hicks, Spencer Wells, Grailey Hewitt, Priestley, Galabin, and Edis, some of whom condemn the operation, while others agree in the main with the author of the paper. The operation, not wholly condemned, is still sub judice, though the cases for which it is acknowledged to be suitable are few and far between.

Other papers of value are two by DR. JOHN WILLIAMS, one on the circulation in the uterus, with some of its anatomical and pathological bearings, and on serous perimetritis, with a third by DR. ERNEST HERMAN on the suppuration and discharge into mucouscavities of dermoid cysts of the pelvis.

BROOKS H. WELLS. LECTURES ON OBSTETRIC OPERATIONS, INCLUDING THE TREATMENT OF HEMORRHAGE, AND FORMING A GUIDE TO THE MANAGEMENT OF DIFFICULT LABOR. By ROBERT BARNES, M.D. Lond., F.R.C.P. Fourth Edition. Illustrated with one hundred and twenty-one woodcuts. Pp. 486. Philadelphia: P. Blakiston, Son & Co., 1886.

"The description of the instruments, the application of the forceps, cephalotripsy, embryotomy, Cesarean section, the practical reflections on narrowing and malformation of the pelvis, ruptures of the uterus, placenta previa, hemorrhage, and, in fact, all the grand questions in obstetrics are treated with accurate good sense. At each instant, by some remark or other, is revealed a superior mind, ripened by having seen much and meditated much. Certain judgments doubtless will be questioned, some operations contested; but these lectures will none the less remain interesting, instructive, useful; and will prove once more that the fatherland of so many celebrated men, as Chamberlin, Smellie, Denman, Burns, Ramsbotham, Simpson, and many others, possesses to-day their worthy successors."

These words, the verdict of Pajot, taken from his introduction to the French version of this work, can most truthfully be applied to this, the fourth English edition.

It would be superfluous to give a thorough analytical and critical review of a book so well known, especially as the operative procedures, the treatment of hemorrhage, and other important