not be escaped, and that when individual health is conserved in highest degree consistent with the requirements of industrial enterprise, all has been done that it is wise to undertake; the case, we think, is fully made up. If overwatchfulness were to protect a few who would otherwise fall, the standard would soon be lowered, and the same exposure would cause a greater amount of the disease. In the long run, outside of cultivating the resisting powers of the race, we can do nothing, and the showy activity of would-be reformers is wasted effort.

D. T. S.

A Manual of Modern Surgery, General and Operative. By JOHN CHALMERS DA COSTA, M. D., Clinical Professor of Surgery, Jefferson Medical College, Philadelphia, etc. With 386 illustrations. 911 pp. Price, cloth, $4.00; half morocco, $5.00 net. Philadelphia: W. B. Saunders. 1898.

In the preface to the first edition the author announced it as his aim to present in concise form the fundamental principles, the chief operations, and the accepted methods of modern surgery, and to place his work between the complete but cumbrous text-book and the incomplete but concentrated compend. Obsolete and unessential methods were excluded in favor of the living and essential. In the new edition no attempt has been made to alter the character or to change the purpose of the manual, although it has practically been rewritten, many entirely new articles added, and a majority of the old articles enlarged, restricted or otherwise altered.

The verdict of the profession must be that the author has faithfully carried out his undertaking and produced one of the very best text-books for students anywhere to be had, and among works of its class might be denominated "Seek no further."

D. T. S.

Transactions of the Southern Surgical and Gynecological Association. Volume X. Tenth Session. Held at St. Louis, Mo., November 9, 10, and 11, 1897. 389 pp. Published for the Association.

The work of the '97 meeting of the association is up to the usual high level of that body. While reading over the list of names we feel disposed to ask why in all this great territory, with the advantages of many large cities, some of these men are not in the lists as authors of text-books in surgery. One of the most interesting discussions is that on uterine cancer, in the course of which Dr. Crofford made the statement that Dr. Jacobs, of Brussels, regarded as the best living operator, had become disgusted and quit operating for cancer of the uterus because of the great certainty of its returning. When asked how he harmonized his results with the reports of other surgeons, his answer was that in the first place, women sought surgeons sooner in other countries, and secondly, there was a great deal of lying about statistics.

One thing is sure, the surgeon who would induce a patient to undergo an operation without laying before her the truth as to the probable outcome, simply for the money that is in it, or the prestige of having added a case to his record, could as creditably turn footpad.

D. T. S.

An American Text-Book of Gynecology, Medical and Surgical. For Practitioners and Students. By Drs. Henry T. Byford, J. M. Baldy, Edwin B. Cragin, J. H. Etheridge, William Goodell, Howard Kelly, Florian Krug, E. E. Montgomery, William R. Pryor, and George M. Tuttle. Edited by J. M. BALDY, M. D. Second edition, revised. With 341 illustrations in the text and 38 colored and halftone plates 718 pp. Price, $6.00, cloth; $7.00, sheep or half morocco. Philadelphia: W. B. Saunders. 1898.

The distinguishing claims of this work are its thoroughness and its practicability. Many of the works on gynecology are too prone to consider the operative side to the almost entire exclusion of the medical side. This work does equal justice to both. The various morbid conditions are fully and clearly described, with a wealth of illustration. The technique of operations could only be made plainer by actual observation, and as to treatment, the confident and positive tone of the authors suggests the assurance, on their part, that the best that is known is recommended.

In the former edition it took place at once in the very front rank, and this keeps pace with all improvements and advancements in details made since the publication of the first. Much new material has been added, and more than forty illustrations have been replaced by new ones. It is a superb work.

D. T. S.

Lectures on Tumors. By JOHN B. HAMILTON, M. D., LL. D., Professor of Surgery, Rush Medical College and Chicago Polyclinic, etc. Third edition. 21 illustrations. 143 pp. Price, $1.25 net. Philadelphia: P. Blakiston, Son & Co. 1898. This is a stenographical report, of course, with revision, of the series. of lectures on tumors delivered by Dr. Hamilton, first at Washington and afterward at Chicago.

No claim has been made to original discovery, and the scope of the lectures is limited to the general pathology, clinical history, and treatment. The work is well gotten up, in a simple, pleasing style, and will answer excellently the author's purpose as a book for recitation and ready refer

ence.

D. T. S.

Atlas of Syphilis and the Venereal Diseases. Including a Brief Treatise on the Pathology and Treatment. By Prof. Dr. FRANZ MRACEK, of Vienna. Authorized Translation from the German. Edited by L. BOLTON BANGS, M. D., Consulting Surgeon to St. Luke's Hospital and the City Hospital, New York, etc. With 71 colored plates. Price, $3.50. Philadelphia: W. B. Saunders. 1898.

Charming as the other members of the Saunders or Lehmann Hand Atlases have proved, this one surpasses. Printed in colors, as this is, in the beginning of the professional career of many who are yet young, such a work as this would have cost a fortune.

The improvement in and cheapening of printing processes and the enormous scale upon which these atlases have been produced, accounts for their cheapness. Truly, this offers a ready and satisfactory substitute for clinical observation, for they are drawn to life.

D. T. S.

Foreign Correspondence.

LONDON LETTER.

[FROM OUR SPECIAL CORRESPONDENT.]

The Cure of Consumption; Proposed Steps to Prevent Spread of Tuberculosis: London Water Supply; Coley's Fluid; The New Hospital Fund; The Royal Army Medical Corps.

An influential meeting has been held in York in aid of the movement, which is receiving much support, by which it is hoped to mitigate the scourge of consumption. Sir W. Broadbent, M. D., combated the prevalent idea that consumption was hereditary. He maintained that what was wanted for its cure was simply open-air treatment, which had been attended with admirable results in Edinburgh, and what was desired was that near every great center of population there should be an institution for the openair treatment of phthisis. Sir William wished every success to the newly formed National Association for the Prevention of Consumption, and trusted that local effort would be made in every town in England to start its own sanatorium. An influential committee was formed at the end of the meeting to formulate a practical scheme for the cure of consumption in Yorkshire.

Sir Samuel Wilks (President of the Royal College of Physicians, London), Sir William MacCormac (President of the Royal College of Surgeons, England), and Sir William Broadbent have addressed a letter to the Chairman of the London County Council on the subject of the prevention of consumption and other forms of tuberculosis. They urge that the Council should take steps to prevent the sale of tubercle-infected milk in London, and secure the proper examination of meat by the substitution of public for private slaughter-houses.

A surprise was in store for those who attended the sale of furniture and ornaments belonging to the late Sir R. Quain, in Harley Street. Quite a sensation was caused when the auctioneer submitted a square of old tapestry from the servants' hall, in the basement of the building, that apparently had been thought to be of comparatively little value, but which after a spirited bidding realized no less than 250 guineas.

Sir W. Crookes, F. R. S., and Professor T. Dewar, F. R. S., in their recent report showing the composition and quality of daily samples of the water supplied to London during the month of September last, state that of the 182 samples analyzed by them, all were found to be clear, bright, and well filtered. The analysts remark that the bacteriological quality of the London water-supply does not depend on the use or rejection of floodwater, but upon the proper regulation and the efficiency of the filtration.

This has long been conducted substantially under the supervision of the official water examiner appointed under the provisions of the Metropolis Water Act, 1871. The direct use of water from the river during a prolonged flood, depending somewhat on the time of the year, may result in the filtered supply containing in solution a little additional vegetable matter, thereby slightly adding to the brown color, but they state that in their experience during the last fifteen years they have seldom, if ever, known the color of the London water-supply, in its most peaty condition, to equal that of the average color of Loch Katrine, Thirtmere or the Welch Lakes. At a meeting of the Medical Society of London, Mr. Battle presented a male patient whom he had previously shown to the society when under treatment by Coley's fluid for a sarcoma which existed as a tumor under the clavicle extending down the chest, another extending above the clavicle in the posterior triangle, with secondary growths over the sternum, along with a number of diseased glands in the axilla. He injected half-minim doses of Coley's fluid into the arm, gradually increased to one-minim doses; the total quantity used did not exceed twenty-four minims. He had met with no rigors or other inconvenient symptoms. The patient's progress had been very satisfactory, the treatment having ceased last May, and at the present time there was no trace of any of the tumors or glandular enlargement. His microscopical examination of portions of the tumors had shown the growths to consist of spindle cells with a few large cells.

Sir Richard Thorne, medical officer of the Local Government Board, in a lecture entitled "The Administrative Control of Tuberculosis," said that the number of deaths registered from all forms of that disease since 1851 had shown a marked and continuous diminution. The rate per million, yearly, for the years 1851-60, was 3,483, and in 1891-95 it was only 2,122, a decrease of 36.2 per cent. There were at the present time some 60,000 deaths annually in England and Wales. The reduction of deaths from the disease of tuberculosis had not been uniform in regard to all forms of it, and in the case of a large class of the most helpless of the populationinfants and young children-it still claimed in almost undiminished numbers its victims. Among the administrative causes which had worked in the direction of diminishing tuberculosis, he had no hesitation in giving the foremost place to the free movement of air in and free access of sunlight to the dwellings and in the places of labor of the population. Where houses were built on the old, vicious system of "back to back," the deathrate from phthisis per thousand lives was 5.2 against 2.8 in cases where free access of air was possible.

In accordance with a plan sketched last summer, a committee have visited and carefully inspected the various hospitals which have made application for a share in the fund which has been collected to assist those hospitals whose income is exceeded by the expenditure. This is a new departure, and it is hoped that the labors of the distribution committee will be greatly facilitated by this system of personal visitation and inquiry.

The President of the Royal College of Surgeons has stated that a career in the Army Medical Service stands in a much higher position than it did before the issue of the recent warrant, for which they might thank the failure of good men under the former conditions and the agitation in which the college had taken a large share. Most of the grounds of complaint were now removed. The army and navy presented openings which were not to be despised. By the new regulations of the Royal Army Medical Corps, a captain before promotion to major must at some time after his seventh year of service pass an examination in surgery, medicine, hygiene, the duties of medical officers, hospital organization, military law, and the administration of the Royal Army Medical Corps. It is also the regulation for all officers under the rank of colonel to retire at the age of fifty-five, and above this rank at the age of sixty, unless specially extended. As to pay, a lieutenant gets £250 a year and a surgeon-general £1,003.

A tale is going the rounds in a north country university town that a leading light recently wrote on the blackboard in his lecture-room, "Professor informs his students that he has this day been appointed honorary physician to the Queen." In the course of his lecture he had occasion to leave the room, and on returning found that a student had added the words," God Save the Queen."

LONDON, November, 1898.

TREATMENT OF FRACTURED PATELLA.-Ball (Practitioner, May, 1898) describes a method of radical operation for transverse fracture of the patella, which may be used in recent cases or in cases which have failed under ordinary treatment. He exposes the joint by a horseshoe flap and cleans out all blood clot. The edges of the fragments are trimmed and a periosteal flap raised from each. A wire rope consisting of eight strands of steel wire is used, and annealed just before being used. This is passed in two separate pieces, the upper piece passing through the quadriceps tendon, and down each side through the tendinous expansion to the level of the fracture. The lower piece is passed through the ligamentum patellæ, etc., in the same way. The two wires are then tightened and twisted together at the sides and their ends hammered flat. The periosteal flaps are united by catgut. The author thinks this method as safe as any subcutaneous wiring, while it has the advantage of exposing the parts to view and cleaning the joint thoroughly. He recommends it in all cases where the surgeon is sure of his antiseptic precautions. He quotes a case of six months' duration, previously treated only by rest in bed, where the fragments were separated four inches. After treatment in the way described, the wound healed in a week; passive motion was begun in two weeks, and the patient walked in a month. A subsequent skiagraph showed the fragments united and the wire rope in situ. No harm apparently results from the presence of the wire rope in the tissues. British Medical Journal.