6 .16-34 IO Bibliography. 13.47 .31 7-38 Deaths for corresponding week of 1891.. 90 98 107 94 OHIO HEALTH BULLETIN. Infectious Diseases reported to the Ohio State Board of Health in 57 cities and towns during the week ending September 16, 1892: 5 1 THE ESSENTIALS OF HISTOLOGY. By EDWARD A. SCHAFER, F.R.S., Jodrell Professor of Physiology in University College, London. New (third) edition. In one octavo volume of 311 pages, with 325 illustrations. Cloth, $3.00. Philadelphia: Lea Brothers & Co., 1892. For the purpose of laying a foundation in the study of histology we know of no better book for the beginner. The scope of the book is limited to essentials; disputed points are not argued, these being left for future investigation. This seems a wise arrangement, and meets with our commendation, because a discussion of disputed points often leaves the novice's mind helplessly confused. The work has so long been accepted as the standard work on histology, and has been in such general use in the histological laboratories, that an extended review is scarcely necessary. The paper and type used in this ediI tion strikes us as being less commendIable than the work itself. An improvement in this respect would enhance the value of the book. I 4 2 Ravenna. I 2 Sidney I 2 Spring Valley.. I I New Richmond. I Toledo 9 Mansfield.. Portsmouth... Ravenna.. Rockford. Salem Sandusky.. Toledo Youngstown.. Whooping Cough: 46124 25I2 Youngstown..... Scarlet Fever: 2 Cleveland 27 I Columbus... Findlay Cincinnati.. I Fremont Ironton New Lexington. 3 Mansfield.. 3 Toledo New Straitsville. .. ologie Normale et Pathologique. By PROFS. G. ARTHAND and L. BUTTE. 214 pp. Paris, 1892. Published by the Polyclinic of Paris. The writers have sought to produce an original work, and clear up some of the less known functions of the vagus nerve. The denomination vagus well expresses the obscurity in which the functions of this nerve have been held. The work is divided into four parts. The first presents that which is known of the anatomy of this nerve, while the second is devoted to the study of the functions and the different organs deIpendent upon it, its action on the larynx, lungs, heart, stomach, intestine, liver, kidney, etc. The third is taken up with the physiology, and the fourth and last chapter is consecrated to the application. of the newly-discovered facts to path 3 6 Youngstown.... I No infectious diseases reported to health officers in 19 towns. C. O. PROBST, M.D., Secretary. ology. The action of the pneumogastric | THE PRINCIPLES AND PRACTICE OF on the digestive organs, kidneys and BANDAGING. elementary nutrition are especially the objects of the investigators' attention. F. H. P. THE PHYSICIAN HIMSELF AND THINGS THAT CONCERN HIS REPUTATION AND SUCCESS. By GWILYM G. DAVIS, M.D. Published by George S. Davis, Detroit, Mich., 1891. The appearance of this book is such as to immediately prejudice one in its favor. A fine quality of paper, splendid type, and clear, clean-cut illusirations the features which produce the are By D. W. CATHELL, M.D., Baltimore, pleasing impression above referred to. Md. Tenth edition. Publishers, 1892. The F. A. Davis Co., Many ideas in regard to the conduct, surroundings and necessities of a physician are here set forth, and in the main we believe the ideas advanced are good; but we are of the opinion that it would serve to reduce physicians to much of a dead level were all of the suggestions carried out. In reading this book we were reminded of the definition a distinguished gentleman once gave of ethics. He said the gist of ethics could be thus expressed: "Keep yourself clean, your person neat, and behave yourself." So in regard to this book we believe that the above short summary includes everything treated of in this book. The publishers have given us a very nice volume, and a convenient for one use. KLINIK DER CHOLELITHIASIS. By PROF. B. NAUNYN, Strassburg, Germany. With five plates, 173 pages. C. W. Vogel, publisher, Leipsic, 1892. This work on cholelithiasis was prepared by Prof. Naunyn, at the request of the Faculty of the University of Strassburg, as a mark on honor to Prof. A. Küssmaul. As its title indicates, it occupies itself with the clinical picture of cholelithiasis; the form, structure and constituents of gall-stones; the physiology of the constituents; the methods of formation of the stones. The causes of cholelithiasis, its symptomatology, its regular and irregular course, its compli cations and correlations with other affections and sequela, are clearly, concisely and systematically considered. The final chapter concludes with the presentation of the therapeutics of this affection, general, special and surgical. Seven excellent plates are appended. F. H. P. The book is divided into three parts —the first dealing with the roller bandage, the second with tailed bandages or slings, and the third with handkerchief bandages. We believe that everything relating to bandages is incorporated in the book, and we therefore cheerfully book on this important subject. recommend it as a most valuable text Brochures Received. Grave Forms of Purpura Hemorrhagica. By J. H. Musser, M.D, Philadelphia. Tuberculous Ulcer of the Stomach. By J. H. Musser, M.D., Philadelphia. Medical Testimony in the Trial of Alice Mitchell for Killing Freda Ward. Reprint from the Memphis Medical Monthly. Whooping cough: Its Management; its Climatic Treatment. By J. H. Musser, M.D., Philadelphia. Reprint from the Climatologist. Habitual Abortion. By E. S. McKee, M.D. Reprint from the American Fournal of Obstetrics and Diseases of Women and Children. Some Clinical Remarks on Dysentery. By J. H. Musser, M.D., Philadelphia. Reprint from the University Medical Magazine. The Limitations and the Powers of Philadelphia. Reprint from the UniTherapeutics. By J. H. Musser, M.D., versity Medical Magazine. On the Gastric Disorders of Pulmonary Tuberculosis. By J. H. Musser,' M.D., Philadelphia. Reprint from the University Medical Magazine. THE CINCINNATI LANCET-CLINIC: A WEEKLY JOURNAL OF MEDICINE AND SURGERY. New Series Vol. XXIX. CINCINNATI, Oct. 1, 1892. Original Articles. DELAYED OPERATION FOR THE REMOVAL OF OVA- WITH REPORT OF ELEVEN CONSECUTIVE CASES. A Paper read before the Cincinnati Medical Society, September 13, 1892, BY RUFUS B. HALL, M.D., CINCINNATI. In presenting this report including all the cases which I have operated upon for the removal of large ovarian tumors since September 1, 1890, at which time I reported seven similar cases, I do so with the hope that they will not be without interest. I do not expect to say anything new or startling, or to advocate any new method of procedure in the class of cases reported in this paper, but to place the cases on record and call attention to the great advantage to be gained by adopting the method, advocated and practiced by Keith, of preliminary tapping of very large tumors in enfeebled patients preparatory to the capital operation of removal of the tumor, as practiced in the tenth case in this report. Ovariotomy for the removal of large tumors of long standing, like the cases reported in this paper, constitute only a very small percentage of the work of one engaged in abdominal and pelvic surgery. This is due to the generally accepted doctrine by the medical profession of early operation in all of these cases. Notwithstanding the strong and almost universal sentiment which prevails in the profession to-day in advis Whole Volume LXVIII. ing early operations for the removal of ovarian tumors, that advice is not always concurred in, or accepted by the patient and her friends, and not infrequently one will not heed the advice of her physician to submit to the operation just as long as they can tolerate their existence. For this reason we must have a patient come under our observation occasionally, like the cases in this report. The cases were not selected as those which promised well after an operation, but on the contrary all were operated upon regardless of their enfeebled condition. All were complicated by adhesions and other complications incident to delay in such cases. Not one could be considered a desirable case for an operation, but the very reverse if the operator was looking carefully after his mortality report. CASE I. Mrs. R, Watertown, Ohio, aged fifty-seven, patient of Dr. Bohl. The tumor was first observed some three years before the operation. When the patient first came under my observation, August 27, 1890, the tumor was so large that she could walk only with great difficulty. She had an umbilical hernia the size of a pint cup. The operation was made September 1, 1890. The tumor was so firmly adherent to the whole wall of the abdomen that it was impossible to separate it and not strip off the peritoneum in places; in fact there were two places as large as the hand where that membrane was entirely removed, and there were also fine pelvic and intestinal adhesions. The hernial sac was cut away. The patient recovered minus the 47-pound tumor and hernia, and is now in perfect health. CASE II. Miss D-, South Lebanon, Ohio, aged eighteen years, patient of Dr. Stevens. Some two years before the operation the patient. was thrown from a buggy and sustained an injury to the abdomen; soon after that the tumor was first observed, and gradually increased in size. Some three months before I saw the case her family physician urged an operation, but instead her parents put her in the hands of some quack institution in this city to have the tumor removed by internal medication, rubbing, etc. After they had become disgusted with this method they took their physician's advice to have the patient operated upon. November 17 the patient came under my observation, and the operation was made November 20. The tumor was of large size, entirely filling the largely distended abdomen, causing indigestion, dyspnæa, and other pressure symptoms. The patient made a rapid recovery and is now in excellent health. CASE III. Mrs. H, Minster, Ohio, aged fifty-two, patient of Dr. 'Dine. The patient came under my observation December 10, 1890, and was operated upon December 13. The abdomen was enormously distended by a papilloma tous cyst and a large quantity of ascitic fluid. The cyst was firmly adherent in the pelvis. Except bronchitis, which annoyed her for ten days after the operation, due to the inability to expectorate mucous, she recovered without incident, and is now in the best of health. CASE IV. Mrs. G-, Troy, Ohio, aged fiftyseven, patient of Dr. Thompson. The tumor was of large size, and patient suffered greatly from pressure when she came under my observation, March 16, 1891. The operation was made March 20. The tumor was a multilocular cyst, with a large part of it made up of small cysts necessitating a long incision. The pelvic adhesions were extensive but not firm. The patient made a rapid recovery and is now in the best of health. CASE V. Mrs. McC, Marietta, Ohio, patient of Dr. Willis, was referred to me March 21, 1891. She had suffered from the tumor for about three years, but for the past three months it had enlarged very rapidly and caused considerable discomfort from its size. The operation was made March 25. The tumor and contents weighed forty pounds. There were firm and extensive omental and intestinal adhesions. The patient recovered from the operation without any unfavorable symp. toms, except that she suffered from a valvular insufficiency which came near ending her existence on the tenth and twelfth days after the operation. She finally recovered, and went home in the fifth week after the operation and is now in her usual good health. CASE VI. Mrs. R-, aged fifty-six, of Knightstown, Indiana, was referred to me by Dr. Thurston, of Richmond, Indiana, May 15, 1891, with a tumor in the abdomen of large size. At that time the patient had anasarca of the legs, and the body was oedematous up to the axilla. She passed but eighteen ounces of urine in twenty-four hours, and onefifth of its bulk was albumen. After ten days of rest in bed, and medication, her general condition was much improved, and the dropsical condition had entirely disappeared, yet albumen remained in the urine. May 25 ovariotomy was made and the patient made a slow but complete recovery, and is now enjoying good health. CASE VII. Mrs. B, aged thirty-seven, Mt. Vernon, Ohio. I saw the case with Dr. Gordon, May 29, 1891. The pa tient had been confined to her bed for four months, and it was with difficulty that she could turn herself unassisted. She had a rapid pulse and a high temperature, with an exceedingly tender abdomen. Ovariotomy was made at her home May 30, and a 38-pound | opened a gallon or more of thick, dark tumor removed with considerable diffi- colored fluid escaped. The cyst, which culty, owing to the firm pelvic adhe- was yet about the size of an adult's sions. She was profoundly shocked head, was removed. One large cavity, and rallied very slowly. This patient which had an exceedingly thin wall, was operated on at her home because had a long rent in it and was collapsed. she was too ill to be moved. She was A tumor about the size of a cocoanut in an exceedingly bad condition to be was removed from the opposite side. operated upon, but that promised her There was general peritonitis. The the only chance, and she won. cavity was thoroughly irrigated and drained. At the time of the operation the patient was suffering from an epithelioma on the bridge of the nose, which had existed for a year or more. She recovered from the operation and went home the fifth week after it was made, but died from the extension of the malignant disease some four months after. She had a slow convalescence owing to the preexistence of some bronchial difficulty, but finally recovered. CASE VIII. July 2, 1891, I was asked to see Mrs. C-, aged seventy, with my friend Dr. George Conner, of this city. She gave a history of some abdominal enlargement for the past six months. Four days before I saw her, while she was alighting from a street car, she fell, the fall causing sharp pain in the abdomen, yet she was able to walk a short distance to her home. She did not call her physician for two days, when he found her suffering from general peritonitis. The doctor had no trouble in detecting the tumor, which was of irregular outline. The abdomen was very much distended. At my first visit the patient had general peritonitis, and I had no hesitation in saying, from the history of her case, that the cause of the peritonitis was a ruptured ovarian tumor. An immediate operation was advised and urged, which was refused by the patient and her friends. At my second visit, July 13, eleven days after the first, the abdominal distension was not near so marked, and yet it was evident that the patient would not long survive unless she could be relieved by an operation. So little encouragement could be given at that time, if the operation was made, that the friends were yet undecided whether to have it performed or not, but consented to an operation on July 16, and it was made early the following morning. At that time the patient had a pulse of 138 and a temperature of 103°. The exhaustion was very marked, and she had the appearance of approaching dissolution. When the abdomen was The case is interesting as illustrating how rapidly a patient may improve after an operation of such magnitude even when she is in extremis, and justifies the stand taken to give the patient the last chance. A feeble woman of seventy years with a ruptured ovary cyst in the abdomen for nineteen days, with a distinct history of septic peritonitis for eighteen days, and yet recovering, seems really remarkable, and it should be one more object lesson to encourage us more than ever before to do our duty in these cases and give the patient the last chance by removing the tumor, even if the chance be ever so small. I presume that none of us are anxious to operate in desperate and unpromising cases for fear we might be blamed for hurrying on a fatal termination; nevertheless this should not prevent us from doing our duty. CASE IX. Miss L, aged eighteen, was referred to me by her physician, Dr. Feaster, of Agosta, Ohio. The tumor had existed for about two years, and had become so large that the patient had great difficulty in walking as well as resting in a recumbent position owing to the pressure from the tumor. The operation was made September 5, 1891, the tumor weighing forty pounds. There was a small tumor on the opposite side which was also removed. The |