THE phenomenal success of Saunders' Medical Hand- Atlases is readily understood by all who have seen the series, they surely demonstrate the pos SAUNDERS' MEDICAL HAND ATLASES. Atlas of Diseases of the Skin, including an Epitome of Pathology and Treatment, by Prof. Franz Mracek, M. D., of Vienna. Authorized translation, edited by Dr. Henry W. Stelwagon, Clinical Professor of Dermatology, Jefferson Medical College, Philadelphia, etc. With 63 colored plates and 36 full-page half-tone illustrations. Cloth, $3.50 net. W. B. Saunders & Company, Philadelphia. sibilities of illustration as an aid to the knowledge of disease, and make a post-graduate clinical course possible for those who cannot visit the larger medical centers, so accurate is the design and so life-like the coloring of the illustrations. It has ever been conceded that illustration is especially valuable in works on diseases of the skin, in this regard this volume is superb. The text, while possibly more abbreviated than might seem desirable, is accurate and sufficiently detailed to make the cases reported clear. Used in conjunction with the more elaborted text-books this and all the series will prove vastly valuable. H. THIS new number among Saunders' Question Compends is a valuable ad SAUNDERS' POCKET MEDICAL FORMULARY-With an Appendix containing various tables and Emergency Matter of Importance to the Practitioner in his daily work. By Wm. M. Powell, M. D., author of "Essentials of Diseases of Children;" member of the Philadelphia Pathological Society, etc. Sixth edition; thoroughly revised; flexible leather, $2.00 net. Philadelphia, W. B. Saunders & Co., 1900. dition to the series. The subject- As a It will also be found a helpful preparatory work to the study of pathology. This will be appreciated by physicians as well as by students. THE present edition of this popular formulary is the result of a complete SAUNDERS' QUESTION COMPENDSESSENTIALS OF HISTOLOGY. By Louis Leroy, B. S., M. D., Professor of Histology and Pathology in Vanderbilt University; City Bacteriologist to Nashville, Tenn.; Bacteriologist to the State of Tennessee, etc. Arranged with questions following each chapter. 72 illustrations. Cloth, $1.00 net. Philadelphia, W. Saunders & Company, 1900. B. revision and enlargement of that now in the hands of the profession. It has been enlarged by the addition of some two hundred new and valuable formulæ, making it one of the most complete works of its kind. The appendix contains the following matter, all concisely and clearly stated: Posological Table; Formulæ and Doses for Hypodermic Medication; Poisons and their Antidotes; Pelvic and Fetal Measurements; Obstetric Table; Diet List for Various Diseases; Materials and Drugs used in Antiseptic Surgery, Treatment of Asphyxia from Drowning; Surgical Remembrancer; Tables of Incompatibles; Eruptive Fevers; Weights and Measures, etc. THIS is a very serviceable and practical book. It covers a much neglected field in applied therapeutics, because, say what we will, diet is, or shonld DIET LISTS AND SICK-ROOM DIET- be, of the very first consideration in applied therapeutics. Thomas has compiled carefully these diet lists; they are reliable, and are based on the scientific consideration of the needs of the patient. The diet lists are detachable and are ready for use. They cover diet in albuminuria, anemia and debility, constipation, diabetes, diarrhea, dyspepsia, fevers, lithemia, obesity, tuberculosis, etc. Formulas for invalids' diet and general rules for giving food, etc., by rectum. Such lists are valuable, and every physician surely recognizes their need. N. SAUNDERS has enlarged this edition, which, too, has been revised by the author. It is a good working guide in the study of pathogenic bacteria, and A TEXT BOOK UPON THE PATHO- pathologist to the Medico-Chirurgical Hospital, Philadelphia, etc. W. B. Saunders & Co., Philadelphia. Third edition, revised and enlarged. Price, $3.25. one of especial service to students. The established practitioner, however, needs this work to keep him familiar with this rapidly developing department of medicine. Every physician sooner or later, if he has any progressive spirit within him, will become a believer in the role that bacteria play in disease. If they read and study McFarland, who has fully and faithfully given the life history of bacteria and the lesions produced by them they will be followers of the modern spirit of laboratory investigation. F. P. N. THIS is an elaborate work, even though small. It is the best book of its kind yet published. Pyle has carefully edited the book, which is the pro A MANUAL OF PERSONAL HYGIENE. duct of himself and six collaborators. The writers are C. G Stockton, who discusses the hygiene of digestion; Fox, who considers the skin and its appendages; Ingals, who tells of the care of vocal and respiratory organs; Randall, who classically almost tells the layman about earache and other disorders of the ear; Pyle, who considers the eye thoroughly; Courtney, who wanders into the by-paths of heredity and education, while elaborating the hygiene of the brain and nervous system; and Stewart, the eminent physiologist of Cleveland, who considers muscular training from the physiological standpoint. We congratulate Pyle on this very timely and well presented manual. He has not wandered away from his text, nor endeavored to make a manual too popular with the layman, so that it would in any way "be the Family Physician." F. P. N. PAPERS for the Original Department should be in hand one month in advance, and contributed to THE MEDICAL FORTNIGHTLY exclusively. A liberal number of extra copies will be furnished authors, and reprints may be obtained at reasonable rates, if request accompanies the manuscript. Engravings from photographs furnished free. Contributions, and books for review, should be sent to the Editors, 312 Century Building, St. Louis. Signature of contributor, for reproduction, should be sent with every article, on a separate slip; use heavy ink, and allow autograph to dry without applying blotter. COLLABORATORS. ALBERT ABRAMS, M. D., San Francisco. FRANK R. FRY, M. D., St. Louis. H. M. WHELPLEY, M. D., St. Louis. FOR Read before the Brainard District Medical Society at Jacksonville, Ill., October 25, 1900. 'OR two months our medical journals have been filled with comments, original articles and editorials relating to the production of general anesthesia for surgical purposes by the injection of a solution of cocaine into the sub-arachnoid space. The surgical mind has always looked forward to anesthesia without unconsciousness as a great advance step which might some day be an accomplished fact. No discoveries have been a greater boon to humanity and given greater facility to surgical advance than Morton's anesthesia by ether and Simpson's anesthesia by chloroform. We must remember that all anesthetics are accompanied by dangers. Any drug, the influence which so completely overcomes the whole economy, must have more or less danger in its application. We can hardly expect to ever have a perfectly safe anesthetic. The discovery of the anesthetic properties of cocain was a great advance in surgery, and permits us to perform many minor operations under its influence with safety, yet the extended use of cocain in large quantities and over large areas has long been known to be very unsafe. In fact cocain is recognized as a treacherous drug, not always effecting patients in the same way, indeed not always effecting the same patient in the same way. Still its use is greatly extending. The eye surgeon could do little without it, and Schleich by his method of infiltration greatly extended its range of usefulness. Yet infiltration anesthesia has some objectionable features. First, it is of short duration. Second, it distends and disturbs the tissues operated on; and third, it has to be repeated in order to prolong the effect. Just now, we are startled with the thought that general anesthesia can be produced by the injection of cocain solution into the spinal canal, yet this is by no means a new discovery. As far back as 1885 J. Leonard Corning, of New York, published (New York Medical Journal, Vol. 42, page 483) his experiments in local anesthesia. In these first experiments he did not introduce a cocain solution directly into the spinal canal, but injected it into the tissues about the cauda equina. Later, he carried his experiments farther and injected the cocain solution directly into the spinal cord, and demonstrated conclusively that efficient anesthesia without unconsciousness can thus be produced. His second article was published in the Medical Record in 1888 (Vol. 23, page 291). In his first report published in 1885, Dr. Corning, concluded with the following: "Whether the method will ever find an application as a substitute for etherization in genito-urinary and other branches of surgery further experience alone can show." By the testimony and the observation of what it may do has seemed to me on the whole worth reporting. Thus we see that Dr. Corning, of New York, deserves full credit for having experimentally and practically demonstrated the anesthetic power of cocain injected into the spinal canal. Just why his valuable observations, which now appear to have been absolutely complete should have been so long overlooked by the surgical world, is difficult to understand. His observations were published in our best and most widely distributed journals, and yet more than five years elapsed before attention was again called to this matter by A. Bier, of Germany. Bier's experiments seem to have been carried on independently of those of Dr. Corning, and to him much credit is due for calling prominent attention to this as a new method of anesthesia in surgery. Quicke's method of puncture was used. The needle is kept plugged until the point enters the spinal canal; the plug is then removed and a few drops of spinal fluid are allowed to escape. The syringe is then attached and a dram of a 2 per cent solution of cocain is injected into the spinal canal, after which the needle is withdrawn. Of course this whole procedure must be carried out under the strictest aseptic precautions. Following Bier's publication in the Deutsche Zeitschrift fur Chirurgie in 1889, a number of experimenters and practitioners took the matter up. The experiments of Corning and Bier were quickly confirmed by other observations. Tuffier (La Semaine Medicale, 1899, page 363, May 16, 1900), of Paris, was one of the first surgeons of prominence to bring this method into general use. He reported a large number of cases with almost uniformly good results. He usually makes his injection between the fourth and fifth lumbar vertebra, but gives little preference to exact location, sometimes selecting as high as between the first and second lumbar. For practical purposes, an imaginary line drawn between the crest of the ilia will pass over the center of the fourth lumbar vertebra. From this point it is very easy to locate any space desired. Injection is easiest with the patient sitting on the edge of the table. O. Kreis (Centralblatt fur Gynakalogie, July 14, 1900) and others have reported the use of spinal anesthesia to relieve or modify the pains of labor. Dr. Marx, of New York (Medical News of August 25, 1900, and Medical Record of October 6, 1900), gives the first extensive reports of the application of this method by American surgeons. Dr. J. B. Murphy, of Chicago, reports a considerable number of operations made under this method of anesthesia. As far as I have been able to become familiar with the reports, only two deaths are reported. Of course compared with ether, two deaths would be a high mortality, yet they may have been due to other causes. By all reports up to the present time the method promises great advance in the treatment of some conditions. All kinds of operations have been performed under spinal anesthesia. Tuffier claims that any operation on a part below the diaphragm can readily be performed in this way. There are two dangers which frequently suggest themselves as likely to follow this method: First, is the danger from the cocaine itself. We will undoubtedly have cases of cocain poisoning, and some deaths on this account. The second, and possibly greatest danger if the method should become general in its application, is from infection. Any one who is not familiar with strict aseptic technique should not attempt spinal cocainization. The puncture must be made with the same care to asepsis as would be exercised in making an abdominal operation. In the Medical Record (October 20th, 1900) J. Leonard Corning, of New York, gives a very interesting article on this subject, in which he devotes special attention to the technique. As this is the best I have seen, I quote freely from his article, as follows: "(1) The needle may be from three and a half to four inches in length. It should be fine, but not over-tempered. The bevel of the point should be short, so that the needle will not require to penetrate the membranes very far, in order to insure the deposit of the solution within them, The needle may be made of gold or platina, which metals being bendable are not liable to break, even when the calibre is small. There should be a small steel nut, transfixed by the needle, sliding freely upon it, and fixable at any point of its (the needle's) length by the aid of a small set screw. When the needle is thrust in, and a few drops of the cerebro-spinal fluid emerge, thus nut is slid down till its lower aspect rests upon the skin. The nut is then fixed in place by tightening the screw, and a further entrance of the needle into the spinal canal effectually prevented. (2) A syringe of glass, graduated up to thirty minims or more, and provided with an asbestos packing, is the best, because it is so easily and thoroughly sterilized. (3) I prefer to employ a short, delicate trocar (see Fig. 1) half an inch in length, to penetrate the thick skin of the back, subsequently passing the needle through the opening of the 'trocar. This permits of the use of a very fine needle. Many of the needles recently employed by others are |