A Practical Treatise on Nervous Exhaustion (Neurasthenia), Its Symptoms, Nature, Sequence, Treatment. By George M. Beard, A.M., MD., Fellow of the New York Academy of Medicine, of the New York Academy of Sciences; Vice-President of the American Academy of Medicine; Member of the American Neurological Association, of the American Medical Association; the New York Neurological Society, etc. Edited, with notes and additions, by A. D. Rockwell, A.M., M.D., Professor of Electric Therapeutics in the New York Post-Graduate Medical School and Hospital; Fellow of the New York Academy; Member of the American Neurological Associa tion, of the New York Neurological Society, etc. Fourth edition-enlarged. Price, $2.00, net. E. B. Treat & Co., 241-243 West 23d St., New York, N.Y. The name of Beard is intimately associated with the subject of neurology, and Dr. Rockwell has for a long time been well and favorably known for his contributions to the subject of electro-therapeutics. The subject of nervous exhaustion, the symptom complex of which, as formulated and named by Dr. Beard, who gave the condition the somewhat abused title of neurasthenia, is one of unlimited manifestations and of little results from a therapeutic standpoint. The electrical treatment of this condition has perhaps been the most satisfactory, and in this work is found a thorough exposition of its application. But no form of treatment appears to be successful without the concurrent adoption of more commonly accepted procedures, such as attending to the diet, tonics and rest. This book is now in its fourth edition, and it would seem to be a work of supererogation for us to endeavor to add anything to the meed of praise that it has already received.

Infant Feeding in Health and Disease. A Modern Book on all Methods of Feeding. For Students, Practitioners and Nurses. By Louis Fischer, M.D., Attending Physician to the Children's Service of the New York German Poliklinik; Bacteriologist to St. Mark's Hospital; Professor of Diseases of Children in the New York School of Clinical Medicine; Attending Physician to the Children's Department of the West-side German Dispensary; Fellow of the New York Academy of Medicine, etc. Containing 52 illustrations, with 16 charts and tables. Mostly original. 268 pages, 534 x 8 inches. Neatly bound in extra cloth. Price, $1.50, net, delivered. F. A. Davis Company, publishers, 1914-16 Cherry st., Philadelphia, Pa.

A very large part of the average general practitioner's practice is necessarily comprised of diseases peculiar to infancy and childhood, and the most important element in the prevention and cure of many infantile diseases is the prescribing of a proper diet. The exigiencies of society and modern civilization are such that there is a large and growing number of infants who are bottle-fed, but the almost universal ignorance of the most suitable diet for bottle-fed babies is an important etiologic factor in the great mortality that prevails among infants who are thus fed, particularly in our large cities where the death rate among the juvenile accretions to our population from cholera infantum and summer diarrheal diseases is simply appalling during the hot months. Dr. Fischer has been an extensive contributor to the literature of infant feeding, and quite welcome is this addition to the textbooks devoted to this subject. In this work he has presented a carefully prepared exposition of practically all that is known and accepted in the feeding of infants in health and disease. Ten years' experience in the children's service of one of the largest children's clinics in this country has equipped the author with an extensive knowledge of his subject, and no practitioner could fail to profit from a perusal of this excellently compiled little work.

Pulmonary Consumption, Pneumonia, and Allied Diseases of the Lungs. Their Etiology, Pathology and Treatment, with a chapter on Physical Diagnosis. By Thomas J. Mays, M.D., Professor of Diseases of the Chest in the Philadelphia Polyclinic; Visiting Physician to 'Rush Hospital for Consumption. Illustrated. Price, $3.00. E. B. Treat & Co., New York, 241-243 West 23d st.

Of the several universally prevalent diseases that are regarded as devastators of the human race, consumption is preeminently the greatest. The therapeutic offerings in this field have not changed in any degree in recent years, but everyone is beginning to recognize that the essential indications in the treatment of consumption are ample nourishment and plenty of sunshine in an equable temperature. Since our therapeutic resources are so limited, it follows that prevention will in fact play the most important rôle in lessening the prevalence of this disDr. Mays has in this work presented a complete study of pulmonary consumption, and as kindred subjects has also considered pneumonia, acute and chronic bronchitis, asthma, etc. Naturally this work is chiefly devoted to the subject of pulmonary consumption, and the author has compiled a large amount of valuable information as to diagnosis and treatment of this fell disease. The work is amply illustrated, and the author cites the histories of numerous cases that may prove valuable for purposes of comparison.

ease.

The Cosmopolitan for April.

The position which the Pierpont Morgan organization holds with reference to the business and political world is discussed by Mr. John Brisben Walker in the April Cosmopolitan under the title, "The World's Greatest Revolution." Familiar with the business world and a student of affairs, Mr. Walker has, while approving of the general idea of concentration which makes for good organization and public economy, drawn a picture of the power now exercised which will be a surprise to the great majority who have not given this subject thoughtful attention.

DOCTOR, MAY WE EXPECT YOU?

We have a brilliant array of new goods. We wish you to see them. Not now nor when you come will we ask you to buy. You will enjoy seeing; we'll enjoy showing.

BRODNAX, The Doctor's Jeweler,

Peabody Hotel Building, Memphis.

GALL STONES; A REPORT OF SEVEN CASES.*

BY FRANK D. SMYTHE, M.D.

MEMPHIS.

I DO NOT think it profitable to consume your time in reading a review of the current literature on this subject. As a matter of fact too many articles are bibliographic-pure and simple. Dr. Krauss with his microscope could not find an original idea expressed in many of the so-called original communications appearing in the journals.

Of these seven patients operated upon, cholecystostomy was performed upon two, cholecystendyse upon four, and cholecystectomy upon one of them.

Cholecystostomy.

Case I. Mrs. B. was referred to me by Dr. Sparkman, of Cleveland, Miss. She was about 25 years of age. She had suffered many attacks of biliary colic during the past two years. The pain was primarily in the region of the gall bladder, though it extended at the time of my visit beyond and under the scapula. The gall bladder could be palpated projecting about one and a half inches below the border of the liver, which organ was slightly enlarged. Urine showed a trace of bile, but no more than we often see in the average case of malarial fever. None of her attacks was followed by jaundice.

She was given chloroform, and an incision was made over the gall bladder, beginning at the cartilage of the ninth rib

* Read before the Memphis Medical Society, March 19, 1901.
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and extending three inches downward along the outer border of the abdominal straight muscle, right. Upon entering the cavity the liver was noticed rather dependent. The bluishlooking gall bladder projected below its border. Examination with the finger revealed the presence of stones in large quantities. The gall bladder was drawn upward and supported in this position while sterilized gauze was being carefully placed about it, shutting off the cavity completely. The fundus of the organ was incised, and by the aid of a scoop about half an ounce of small stones was removed, some fluid bile, stringy mucus and serum, also one large stone was found impacted in the cystic duct, completely shutting off communication with the common duct. With angular forceps, aided by the finger from below, this was removed and a uterine sound was passed through the duct into the duodenum. The gall bladder was the subject of chronic catarrhal inflammation. It was irrigated thoroughly and an application of nitrate of silver-20 grains to the ounce-was applied to its inner surface. The incised edges were sutured to the parietal peritoneum and fascia-a few sutures previously introduced partially closing the abdominal incision.

The patient left the hospital eleven days after operation, and her physician wrote me one month afterward that the fistula had about closed. Six months later she had had no return of attacks. The opening had long since closed and the patient was entirely relieved.

Case II. Miss Mary C., aged 27, residing in Memphis, consulted me during the summer of 1900, complaining of severe pain in the region of the gall bladder. Her temperature was 100°F. This fever had resisted quinin. Two physicians had been attending her for some time, and had given her the usual treatment for malaria. From this treatment she derived no benefit. Her history was one of repeated attacks of hepatic colic. These attacks would last from six hours to two or three days. The pain was sharp and seemed to involve the entire liver region. Fever was the rule. She was never jaundiced.

Chloroform was given the incision made along the outer border of rectus muscle about two and a half inches long. I will say here that the gall bladder could not be palpated through the abdominal parietes. Adhesions of the omentum were broken up when the gall bladder came into view. After surrounding it with gauze it was drawn upward and forward by ligatures that had been passed through the fundus. It was incised and a large, rough stone was removed-size of a wren's egg. The gall bladder was ulcerated and contained pus,

mucus and bile. The edges of the organ were stitched to the peritoneum and fascia, a drainage tube inserted and the discharge carried to a receiver enveloped in dressing. This patient left the hospital within three weeks with the fistula closed. I saw her a short while ago and she had had no

recurrence.

Cholecystendyse.

Case I. Miss of Memphis, was referred by Dr. B. F. Turner. She was about 20 years of age, and had practically been an invalid for over a year. She suffered pain constantly in the region of the right side-notably the gall bladder, and for a change would have at an interval of from one week to one month attacks lasting several hours, the most agonizing pain, involving the right side and extending behind, under the scapula. The pain would never leave the region of the gall bladder entirely, though at times it radiated widely. Dr. Turner made the diagnosis of biliary calculus and advised operation. This she persistently refused for a long time, and would have done so to this good day had not Dr. Turner steadfastly refused to administer opiates. Jaundice was never a symptom with her. She had suffered from gastro-intestinal indigestion, and was very languid and melancholy. The gall bladder could be felt with the finger, just about as in a normal case, projecting slightly below the border of the liver.

Chloroform was given. Incision was made as in the other cases. The organ was found to contain nine faceted calculi, cubical in shape and about the size of the average dice; they were rather hard and bronzed. Six of them were found loose in the gall bladder, two were imbedded in the cystic duct and one in the common duct. All of them were removed intact but the one in the common duct-this was crushed with padded forceps and afterward conveyed in the duodenum by means of a long probe. After irrigating the gall bladder the incision was closed and the bladder dropped back to its normal position. The technique of the closure is as follows: Approximate the edges by fine silk, the needle passing through all the coats of the organ incised, very near the margin of the incision; over this line of sutures another of Lembert's sutures is employed, thus the better guarding against leakage and insuring more prompt union. The patient did nicely, and left the hospital twelve days after operation.

Case II. Mrs. from Marked Tree, Ark., was referred by Dr. Krauss. She had suffered eighteen months with pain in right side, most intense over the gall bladder. The monotony of this dull, aching pain would be broken about once a month,