Incompatibility, Prof. S. O. L. Potter, Author of "A Hand-book of Materia Medica and Therapeutics." A New Complete Table for Calculating the Period of Utero-Gestation. Sylvester's Method for Artificial Respiration. Illustrated. Diagram of the Chest. Anæmia.-By Frederick P. Henry, M.D., Prof. of Clinical Medicine, etc., etc. Pp. 134. Price, 75 cents. P. Blakiston, Son, & Co., Phila. This, the first systematic treatise on anæmia published in this country, is a reprint of a series of articles published in The Polyclinic during the past year, and embodies the results of many years' study of the blood and the disorders consequent upon its imperfect elaboration. The statements which it contains are, for the most part, based upon personal observation, and where this has been wanting, upon accepted facts of physiology and pathology. The author has endeavored to supply the want of a trustworthy guide to a wide and growing field of research -a want which he himself has keenly felt. Manual of Clinical Diagnosis.-By Dr. Otto Seifert and Dr. Friedrich Müller. Third edition, with sixty illustrations. Pp. 173. Translated by William Buckingham Canfield, A. M., M.D., Fellow of the American Academy of Medicine, etc., etc. G. P. Putnam's Sons, New York and London. The translator, in the preface, says: "The favor with which this book has been received in Germany, and its eminently practical and concise manner of dealing with the different important points in diagnosis, seem to justify its translation into English. It has been brought down to the latest acquisitions of science, thus representing the most advanced views." M.D., Boston, Mass., with the collaboration of Profs. T. G. Thomas, W. G. Wylie, W. K. Polk, Dr. Laskie Miller, and Dr. Andrew F. Currier. The first and October number of this new journal has just appeared. The names on its editorial staff are a sufficient guaranty of its excellence. The original articles in this number are: Pathology of Erosions, by E. W. Cushing, M.D.; Lithopædion, by W. H. Fales, M.D.; Expulsion of Uterine Myomata, by A. F. Currier, M.D.; Aveloz in Uterine Cancer, by J. E. Janvrin, M.D.; and four editorials on various topics. The publishers are Lockwell & Churchill, Boston. The Journal of Morphology.-Edited by C. O. have been received from many of the most eminent investigators in this department. The Journal will be issued in the best style, with elaborate lithographic plates. It is published by Ginn & Co., Boston, New York, and Chicago. PUBLISHERS' NOTES. Fats as Tonics. — Fats, especially those which are of easy digestion, like The authors' endeavor has been to give "in an cod-liver oil and sweet cream, are also epitomized form, the different methods of examination, as well as a convenient collection of those data essential to the well-being of the nervous and figures which should always be familiar to the system. The peculiar substance-neurene physician and student." That this has been well-found in all nervous structures contains done a perusal of the pages of the book will show. fat as an essential constituent. It is reDifferential Diagnosis: a Manual of the Com-markable that most "nervous" individuals parative Semeiology of the More Important have a strong aversion to fats as articles of Diseases.-By F. de Havilland Hall, M.D., Third American edition, thoroughly etc., etc. revised and greatly enlarged. Edited by Frank Woodbury, M.D., etc. 8vo., pp. 255. D. G. Brinton, Phila. The contents of this book are outlined in its title. It does not pretend to treat of the differential diagnosis of all diseases, but wisely confines itself to the commoner, more important ailments. The differential diagnostic points are arranged, in many instances, in parallel columns. The author first takes up general diseases, of which he makes two groups only-fevers, and diseases of the blood. In the second part of the book the author takes up local diseases, using a physiological rather than an anatomical classification. The work, on the whole good, is not free from errors, as a glance at page 103 will show-where, a disease is located in the termination of the cord low down in the sacral canal," and "in the cord at the upper limit of the sacral region," every firstyear medical student knowing that the spinal cord does not reach the sacrum at all. The Annals of Gynecology: a Monthly Review of Gynecology, Obstetrics, and Abdominal Surgery. Edited by E. W. Cushing, diet. This is extremely unfortunate, for the omission of fats and oils from the diet tends to not only continue the nervousness, but to increase the irritability and weakness. Cod-liver oil is a most valuable medicine in such cases, because it is already partly digested by admixture with the bile secreted by the liver of the fish, and thus rendered still more easy of absorption. The labor of digestion is thus partly taken away from the tasks to be performed by the invalid. The fishy and unpleasant odor and taste are objectionable, and many patients cannot take it; this difficulty is believed to have been overcome by Scott's Emulsion of Cod-liver Oil with the Hypophosphites, which is so palatable that it can be taken and retained by the most delicate, and as this Emulsion does not separate or change, the dose can always be depended upon to be alike. Phillips' Emulsion of Cod-Liver Oil, by reason of its originality and distinctive features, attracted attention on its introduction in this market. It has stood the test of years, gained many friends in the profession, and has established its claims to minute division, miscibility, palatability, ease of administration, and assimilation. Physicians who have not examined this preparation will find it worthy their investigation and trial. Celerina.-H. A. Spencer, M.D., Surgeon-in-Chief, Pennsylvania R. R. Co, Erie, Pa., says: I have used Celerina and am well pleased with the result. I find it a very valuable remedy in nervous cases, and in one case of mild insanity resulting from change of life, in which I had tried all the usual remedies with unsatisfactory results, I found the Celerina to control the difficulty better than any thing I had tried. The patient is still using it, and is, I am glad to say, improving. I am also using it in several cases of neurasthenia, insomnia, and impotency, with quite satisfactory results. From my experience, I do not hesitate to commend it to the favorable notice of the profession. Food for Invalids.-Hundreds of invalids fail to regain their health and strength because of inability to digest and assimilate their food. If they would use the Lactated Food, they would find it an article which is most easily digested, and will be assimilated by the stomach when all other foods fail. It is predigested, nonirritating, and has great nutritive properties. It can be prepared in many different ways, and is a palatable and delicate article of diet. Send for pamphlet, giving important medical opinions on the "Nutrition of Infants and Invalids," to Wells, Richardson, & Co., Burlington, Vt. Retreats, Sanitariums, etc.-The attention of our readers is called to the different institutions advertised in this number of the ANALECTIC. Prof. Loisette's Memory Discovery.-Prof. Loisette's new system of memory training, taught by correspondence at 237 Fifth Ave., New York, seems to supply a general want. He has had two classes at Yale of 200 each, 250 at Meriden, 300 at Norwich, 100 Columbia Law Students, 400 at Wellesley College, and 400 at University of Penn., etc. Such patronage and the endorsement of such men as Mark Syrup of Hypophosphites. — The success attending the use of the various oxides and salts of phosphorus in medicine has led to the manufacture of innumerable preparations of this class. Dr. McArthur's Syrup of Hypophosphites was among the first of these, and its superior purity and efficacy have enabled it to keep far in advance of its competitors.-Popular Science News. In various W. S. Leonard, Hinsdale, N. H., says: I Horsford's Acid Phosphate. - Dr. have used Horsford's Acid Phosphate in my practice for the past eight or ten years, sults obtained from its use. and have been much gratified with the reforms of dyspepsia it reaches a class of cases that no other medicine seems to touch, and I have repeatedly seen patients, where opiates were contra-indicated, obtain refreshing sleep and rest at night from a single dose at bedtime. Crystalline Phosphate. - GENTLEMEN: I have received a small package of your Crystalline Phosphate, and have been prescribing it in my practice, and find that it does every thing that it claims to do. I have also prescribed it for myself in chronic dyspepsia and nervous prostration, and find it is par excellence of the day as a nerve food and a nerve tonic. WILLIAM TAYLOR, L.R.C.S.L E. MEDICAL ANALECTIC A MONTHLY EPITOME OF PROGRESS IN ALL DIVISIONS OF VOL. IV., No. 12. EDITED BY R. W. AMIDON, M.D. December, 1887. WHOLE NO. 48. age tube is often very marked after the administration of a free purge. The choice of the purgative depends somewhat upon the nature of the case. When there is excessive vomiting it may be necessary to employ small, frequently repeated doses of calomel. In most instances, however, there is no better purgative than sulphate of magnesia. It produces large serous evacuations and no intestinal irritation. Med. and Surg. Reporter, Oct. 22, 1887. LEADING ARTICLES. Penrose (C. B.) on Sulphate of Magnesia in Abdominal Distension and Peritonitis after Laparotomy. The administration of a purgative for the relief of the abdominal distension and peritonitis which sometimes follow laparotomy was first advised by Lawson Tait. The treatment is also advocated by Greig Smith and by other surgeons abroad and in this country. There is at the same time a strong tendency among many physicians to adhere to the routine practice of administering large doses of opium as soon as any symp--The subject of abdominal surgery has for toms of peritonitis are manifest. The abdominal distension which follows laparotomy is due to paralysis of the muscular coat of the intestine. In the simplest cases this distension lasts but a few days, and is caused by the diminished tonicity of the intestine muscles from exposure, manipulation, or relief from intra-abdominal pressure. In other cases it may precede or accompany peritonitis, and the muscular paralysis is caused by the inflammation of the serous covering of the intestine. Baldy (J. M.) on Salines in Peritonitis Following Abdominal Section. the past few years been so freely discussed, and operators all over the world have been so busy collecting together such numerous statistics and perfecting details, that most of the operations performed to-day are fast settling down into their permanent positions in the surgery of the future. The technique of the several operations has been so thoroughly digested that there remains but little to be said in this connection, excepting in a few instances. The subject of the after-treatment, howThe results of abdominal surgery show ever, has not been brought so constantly that it is not necessary to paralyze the in- before the profession; and operators are testinal tract further by the administration apt to think it not worth while to bring litof opium. The danger of moving the bow-tle details which they deal with every day, els after exposure of the peritoneum has been much exaggerated. It seems probable that the peritoneum is subjected to at least as much irritation from the tension and movement caused by the distending gas as it would be from any peristaltic motion of the muscles of the intestines. and take as a matter of course, prominently forward and to notice. It is well known to surgeons that the management of these cases, after the operation, is of prime importance, and that many a life would here be lost but for the most careful and skilled treatment; and so the results of a seemingly perfect operation be annulled. A free, watery purge encourages peristalsis and the escape of gas. It depletes con- The particular phase of the after-treatgested peritoneal vessels, and probably ment which I would urge upon the attendrains off, through the intestines, serum tion of the profession at this time is the which was contained in the peritoneal cav- management of those patients in whom perity. The diminution in the quantity of the itonitis is beginning to develop or has alserum discharged from an abdominal drain-ready gained full headway. This dread complication, arising when least expected, and sometimes after we have considered the patient out of danger, has in the past been reported as the cause of death in a multitude of instances; in fact, twenty-five per cent. of the deaths following abdominal section are attributed by one writer (Agnew) to this cause. Even with our present perfected methods of operating, we still see this disease arising constantly. With this complication ever in mind, I have, since beginning to practise abdominal surgery, followed the example set by Mr. Tait, of never taking any steps to prevent a movement of the bowels after operation, and have fallen into the habit of routinely administering salines in small, often-repeated doses, sometimes as early as the second, generally on the third, day, provided the bowels have not been opened spontaneously at this time. The results have been, without exception, most satisfactory. The patient has invariably been more comfortable after a passage has been secured, and in cases where a drainage tube has been used the discharge has been markedly lessened from the time the purge began to act. Where there is much persistent bilious vomiting present most gratifying results are obtained. I have yet to see a single unfavorable result arise from this treatment. Dr. Wylie, of New York, taking the hint from Mr. Tait has been in the habit of opening the bowels by enemata and purgatives, even during the first twenty-four hours after operation"; and he says, "when tympanites or eructive vomiting begins, I at once move the bowels by turpentine or ox-gall enemata, or by a seidlitz powder or Rochelle salts." Dr. J. Taber Johnston, in a paper before the recent International Medical Congress, has urged the same line of treatment in these cases; it has also been the course pursued by Dr. Price, of this city. So it would seem that surgeons are beginning to adopt the saline treatment in preference to the opium in cases where there arise the commencing symptoms of peritonitis. I would, however, go further than this, and urge that the same line of treatment be followed in cases where the disease is fairly well developed, and that at all hazards the bowels be induced to discharge free watery stools as soon as possible. It is surprising to see how quickly all symptoms begin to subside when this is accomplished. In cases of distension, vomiting, elevated temperature, and quick pulse, etc., Mr. Tait gives small doses of magnes. sulph. every hour until the bowels are opened, and says: "If these symptoms advance to an alarming extent, I use still more active measures to get the bowels moved, because I always find that as soon as a motion has passed they rapidly disappear." My own experience is in exact accordance with that of Mr. Tait, and the following case, which has only recently occurred, well illustrates the rapidity with which all symptoms abate under such management: Mrs. S, thirty-three years of age; three children; married ten years; last child five years ago. Has never been pregnant since this event; has always suffered since, and has been gradually getting worse; is only able to work a few days at a time. On September 13th I removed from the left side of pelvis an ovarian cyst as large as a good-sized orange, slightly adherent to pelvic walls and rectum; a cystic-degenerated ovary, and a beginning cyst of the Fallopian tube from the right side; a cyst containing about a drachm of straw-colored serum from the fundus of the uterus, not connected with either tube. As usual, on the third day her bowels were moved gently with salines, and she was doing as well as it is possible for a patient to do; she so continued until she had passed nine and a half days. The stitches had been taken out on the fifth day, and union found to be perfect. I had promised her that she might get up in three more days. I have since discovered that she had been getting out of bed for the past four or five days to shut doors, windows, and to have her bowels. emptied. On the 21st of the month she complained of a slight soreness in the left ovarian region. On the 22d, however, she was feeling better, and had not so much pain as the day before. At eight o'clock that night I was summoned to her, and found her just coming out of a violent chill; abdomen slightly swollen; pain increased. She was ordered an ounce of Rochelle salts in divided doses, which she took during the night. In the morning I found she had slept none all night, and was then very much worse-alarmingly so. By noon her temperature and pulse were high, her abdomen extremely swollen and barrelshaped, tympanitic, and so excessively painful that she could not stand the weight of the bedclothes; knees drawn up; anxious expression of face; dry, parched tongue and lips; vomiting. The small doses of salts had not acted, and she was growing rapidly worse. Influenced by my experience in milder cases, as well as some most excellent results obtained by Dr. Charles Penrose in fully developed peritonitis, I administered an ounce of magnes. sulph. in a concentrated solution, and ordered the dose repeated twice more, at intervals of an hour and a half, should her bowels not be moved in the meanwhile. She was given both doses, besides receiving two or three large (several quarts) turpentine enemata. About two o'clock her bowels were slightly moved, and within the next thirty-six or forty-eight hours she had about fifteen large watery stools. From the time her bowels began to act she began to improve in every symptom-her pulse and temperature dropped; she never vomited after the second passage; by the next morning the swelling of the abdomen was markedly less; the tympanites had subsided to a very great extent, and her abdomen could be manipulated pretty freely without causing her much pain; her whole appearance was improved, and her countenance showed immense relief. She slept quietly almost the whole of that night, and went on steadily improving until final recovery. any one trying to make them move will be quickly convinced of this fact-therefore for this purpose opium is superfluous. The drug relieves the pain, it is true, but oftentimes it does not even do this, except in enormous doses. Relief of pain is practically all that opium can do for good in peritonitis. It, however, does a world of harm-it helps to keep the bowels in splints, and so favors the formation of those great masses of adherent intestine which we find so often the cause of subsequent intestinal obstruction; also the formation of numerous bands of organized lymph, which as often bring a patient to grief in after-years; still worse, it closes all the avenues of escape for the poisonous products of inflammation formed in that great lymph-sac, and in this manner supplies material, the best possible, for keeping up and spreading the inflammation, much more surely than the rubbing together of the parietal and visceral peritoneum will. With salines, on the contrary, the bowels are kept in active peristaltic motion, and this very motion tends to prevent the formation of adhesions and bands; they literally drain the peritoneal cavity of all products of inflammation. This is not merely theoretical, but has been repeatedly observed. A case in the practice of Dr. Heretofore I have treated cases of peri- Penrose showed this most satisfactorily. tonitis on the opium plan. In one case I A large dermoid cyst was ruptured during gradually increased the dose of the tincture the tearing away of adhesions, and emptied of opium until the patient received on one its contents into the abdominal cavity; in day between sixty and seventy grains of the spite of a most careful irrigation a violent drug. I have never been satisfied with this peritonitis developed; from the appearance kind of treatment, nor have I ever been of the first symptom, the drainage tube able to convince myself that it was even which had been put in began to increase logical; it has heretofore been followed its discharges until it was almost impossible simply because all authorities recommend to keep it dry and clean; as soon as the it and strongly condemn purgatives. The bowels were induced to act the discharges rate of mortality in peritonitis is terrible, diminished and quickly ceased altogether. and the results of the cases treated with This patient had about twenty-one free opium will stand, I believe, in the future in watery discharges per rectum. Theoretimarked contrast with those treated with cally the peristaltic action would cause salines. Practically, so far as tried, salines much pain, but practically the increase is have proved themselves satisfactory beyond slight, and the pain soon is gone altogether. anticipation, and if such results are con- That the peristaltic action increases the tinued the time will come when opium will inflammation is, I believe, a myth. The take the place now occupied by purgatives saline so depletes the blood-vessels of the among authorities. Logically, salines are peritoneum and intestines that the inflaminfinitely better than the narcotic. We are mation soon has little to feed upon, and taught that opium "puts the bowels in the bad tendency of friction has but little splints," and in this manner keeps the peri-weight as against the great good obtained toneal surfaces from rubbing together and by depletion. increasing the inflammation. But the bowels are already in splints, as it were, and There are dangers, of course, from the administration of large doses of salines and |