The author has enjoyed an unusually extended experience in the treatment of these diseases, and he has done so to good purpose; being enabled to say positively what remedies-no matter how well recommended and time-honored-have proven inert, and what ones he has found to be valuable. His great aim has been to thoroughly prove all his statements. The book is thoroughly good. Elementary Microscopical Technology. A Manual for Students of Microscopy. In Three Parts. Part I. The Technical History of a Slide, from the Crude Materials to the Finished Mount. By Frank L. James, Ph.D., M. D., American Society of Microscopists, etc. 8vo., cloth, pp. 197. St. Louis Medical and Surgical Journal Company, Publishers, St. Louis, Mo., 1887. The talented microscopist of the St. Louis Medical and Surgibal Journal has given us in this book a thoroughly instructive and entertaining monograph on microscopic technology. It is a most excellent work for those who are interested in microscopy, and we shall look with interest for the succeeding volumes. The Treatment of Hemorrhoids by injections of carbolic acid and other substances. By Silas T. Yount, M. D., physician to St. Elizabeth Hospital; member American Medical Association, etc. cloth, pp. 64. Lafayette, Ind. 12mo., The above is the title of a very excellent little monograph, giving full and explicit instructions in regard to the treatment of hemorrhoids by injections, based upon the author's extended personal experience. A Year-Book of Treatment for 1886. A critical review for practitioners of medicine and surgery. Philadelphia: Lea Brothers & Co. 1887. Columbus: George H. Twiss. 8vo.; cloth; pp. 304; $1.25. This is like the other volumes of this series, issued by the same house, which we have noticed annually as they have appeared. Each department of practice is fully and concisely treated, such recent pathological and clinical work as bear directly on treatment being included. A Handbook of General and Operative Gynecology, Volume 1. By Dr. A. Hegar (University of Freiburg) and Dr. R. Kattenbach (University of Giessen). In two volumes. This is also Vol. VI. of "A Cyclopedia of Obstetrics and Gynecology" (12 volumes, price $16.50), issued monthly during 1887. New York: William Wood & Company. Occurring in the Practice of FRANK J. WEED, M. D., Professor of the Principles of Surgery and Clinical Surgery, Medical Department of the University of Wooster, Cleveland, Ohio. Reported BY CHAS. H. MERZ, M. D., Clinical Assistant to the Chair of Surgery. The subject of this sketch was a boy, thirteen years of age, of German birth. He was admitted to the University Hospital on July 8th, 1887. When admitted, he was in a comatose condition. He could not be aroused by shouting close to his ear, nor did he shrink in the least from the pain inflicted by pinching or pricking him. Respiration was regular, but very labored. Pulse eighty and full. Pupils were equally dilated and immovable. Upon examination, several cicatrices were found upon the right side of the head in the temporal region, about the anterior inferior angle of the parietal bone, and a distinctly depressed area about IX 1.5 in. in extent. Two small sinuses which were discharging pus were also discovered. Patient rested quietly all night, but could not be made to swallow any food. About 7:30 A. M. he seemed to awaken, and commenced to sing, "Yankee Doodle." He lapsed Into silence again, and in about half an hour cried out: "Look out for my hair; don't pull it!" His former history, as given by the attending physician, Dr. Johnson, is as follows: Six weeks previous to his admission to the Hospital, he was kicked on the head by a horse which he had led to pasture. The soft parts were not extensively injured; a cut, about an inch long, and a punctured wound were all that could be discovered. He was injured During this in about 6 P. M., and the doctor saw him about 10 P. M. terval he had been unconscious, but towards 10 o'clock the next morning the stupor had passed off. The diagnosis of fracture at that time was very difficult to make, and, as the boy continued to improve, he was not subjected to any surgical treatment. Three or four days before he was admitted to the Hospital, exposure to the sun led to the development of unfavorable symptoms. He became partially unconscious, and, as his condition was growing more serious, he was brought to the Surgical Clinic of Dr. F. J. Weed, in the condition above described. The objective examination upon the operating table confirmed the diagnosis of a depressed fracture of the skull, and made it evident that trephining was not only justifiable, but urgently necessary. The surface temperature, taken over the seat of injury, just previous to the operation, was 99.5° F. The surface thermometer used was Seguin's, manufactured by Tieman. After shaving the portion of the scalp over the depressed area, and cleansing thoroughly with bichloride (1-2000), a free incision was made down through the soft parts and periosteum. The latter was carefully loosened and reflectcd, and the trephine applied to the solid bone. From this point the elevator was used in removing the fragments. At the point of most complete fracture a collection of pus was found. Thirteen fragments were removed. The bones were crushed into small pieces, the largest of which was not more than an inch in length, and from that to the size of a pin head. Some of the pointed pieces had penetrated the dura-mater and lay imbedded in the brain, while two teaspoonfuls of pus and brain matter oozed out. Treatment consisted in removing all the fragments of bone which might afterward become necrosed and cause trouble, and in rasping the edges of the remaining bone. After removing every particle of foreign matter, the wound was irrigated with a solution of mercuric bichloride (1-3000). Iodoform was dusted over it, the flaps replaced and held by a wet roller. The boy was removed to his cot and rallied well from the operation. He took nourishment freely, and fortunately manifested no bad symptoms from the anesthetic employed (chloroform). The evening temperature was 100° F., and the next morning 99°. Leiter's cold water coil was applied to the head for the five days succeeding the operation, but there was no inflammatory reaction. The bromides of sodium and lithium were administered to diminish blood pressure and produce sleep. Showing shape and size of the fragments removed. On the fifth day, local symptoms of an accumulation of pus were noticed, and one of the flaps was loosened from its attachments and the pus evacuated. A hernia cerebri developed on the sixth day, and its general outline is shown in the cut. Pressure was made for several days by means of a piece of gutta percha, about three inches square, which was placed directly over the hernia and held in place by a roller. Under this treatment the hernia gradually disappeared. The fragments of bone removed were thirteen in number, and gave an area of 34 square inches. The necessity for antiseptic treatment seems to be specially important in brain surgery. In this case, it seems very probable that the risks were diminished and success made more certain by its employment. The wound was always dressed under the carbolic spray, and iodoform was used freely. At this date, 106 days after the operation, the boy is well, and has so far recovered his former strength as to be able to serve as an errand boy about the Hospital. He has suffered in no way from the injury, being bright and active as he was before it was received. The wound has closed, with the exception of a slight line of granulation, which has so far remained uncovered. A careful examination of the wound was recently made. It was found to be located one inch anterior to and on a level with the lower end of the Rolandic line. This would be a little above the speech center, and over the motor center for the face (Seguin), and in fact the only cranial symptoms observed would emanate from injury to this point. A slight paralysis of the facial nerve on the left side still remains. It affects more particularly the orbicularis oris muscle. When the face is in perfect repose there is very little deformity, but when the patient laughs or speaks it becomes very apparent. While the indications for trephining were comparatively plain in this case, they are not always so. The surgical treatment of injuries to the brain is daily becoming more clearly defined, and in many recent cases the advantages attendant upon operative procedures more than counterbalance the risks and dangers incurred. In Pepper's System of Medicine, Vol. V, Dr. E. C. Seguin says: "The indications for trephining or raising bone after cranial injuries, for the relief of symptoms of cranial irritation, compression or degeneration, may be conditionally stated as follows: * * (a) When aphasia supervenes immediately, or within a few days or weeks after an injury of the anterior portion of the head on the left side. It is extremely probable in the first case, a clot or bony spiculum will be found compressing the speech center; in the second case, that an abscess has been formed in or near it. (Broca's case.) * (c) In conditions of stupor and coma, after cranial injuries, sometimes without external wound, in which meningeal hemorrhage is the cause of impending death, the discovery of slight hemiplegia should justify trephining, planned according to the topographic rules above laid down (Weir's case, 1882). In some cases, latent hemiplegia may be discovered |