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was often lost. There was one drug that seemed to do some good in the condition and that was the ammoniated tincture of guaiac.

Dr. SAUTTER had mentioned the case of the man with a fistula in the posterior portion of the urethra in which the posterior part recovered under balsams, while the anterior, which was not subjected to the flow of the urine, did not. Might this not have been due to the simple mechanical washing by the urine ?

Dr. WARD said that no doubt the quinine treatment in gonorrhoeal rheumatism was recognized, but he did not think that it was always as efficacious as Dr. Jenkin's case suggested. The bane of his life in the Albany Hospital was a case of gonorrhoeal rheumatism that had been treated by Dr. Hun for three months with quinine. He had had the best results with rest in bed, quiet, the local application of cold, and the administration of alkalies. In his experience with the acute stages the good old Lafayette mixture was better than any irrigation. In answer to Dr. Sautter's question he thought that gonorrhea in women certainly began at times in the vagina. No doubt it began as a urethritis at times.

Dr. SAUTTER stated that in Vienna Wertheim taught that the gonococcus was deposited in the vagina and migrated to the urethra. The vagina might be itself affected later. As regards the alkaline treatment he did not think that it relieved pain. The pain, he thought, was due to the distension of the inflamed urethral walls by the urine. He agreed with Dr. Ward as regards the efficacy of rest in bed. In Munich the students had a separate ward to themselves and were always put to bed when they had gonorrhoea. Posselt, who was in charge there, did not think that this rest in bed modified the disease much, but thought that it lessened the danger of complications.

A motion to adjourn was made by Dr. Ward and seconded by Dr. Vander Veer and was carried.


President. Secretary.

International Congress of Medical Electrology and Radiology.- At the request of the French Society of Electrotherapy and Radiology, the International Congress of Medical Electrology and Radiology, the initiative of which it has taken, is connected with the International Congress of 1900.

A Commission, which is composed of Messrs. Weiss, Professor at the University of Paris, President; Apostoli and Oudin, Vice-Presidents; Doumer, Professor at the University of Lille, General Secretary; Moutier, Secretary; Boisseau du Rocher, Treasurer, and of Messrs. Bergonie, Professor at the University of Bordeaux; Bouchacourt, Branly, Professor at the Catholic Institute of Paris; Larat, Radiguet, Villemin, Surgeon of the Hospitals of Paris, has been asked to assure its organization. This Congress will take place in Paris, from the 27th of July to the ist of August, 1900. All inquiries for further information must be forwarded to Prof. E. Doumer, General Secretary, 57 Rue Nicolas-Leblanc, Lille.

Book Reviews

A Manual of the Diagnosis and Treatment of the Diseases of the Eye.

By Edward Jackson, A.M., M.D., Emeritus Professor of Diseases of the Eye in the Philadelphia Polyclinic; formerly Chairman of Section on Ophthalmology of the American Medical Association; Member of the American Ophthalmological Society; Fellow and ExPresident of the American Academy of Medicine. 600 pages, 178 illustrations and 2 colored plates. W. B. Saunders, Philadelphia,

1900. The name of the author is a sufficient guarantee of the excellence of the work and the profession is to be congratulated in having a book from the pen of so eminent a teacher and scholar. i'he writer is recognized as one of the best oculists in America and as having no peers in the science of refraction. He has incorporated his ideas in a compact volume in an interesting, clear and concise manner, showing much originality of thought and research. Like many writers of the day, he takes it for granted that the student has a basic knowledge of the gross and minute anatomy and physiology of the eye and plunges directly into the practical handling and treatment of the ocular diseases and errors of refraction.

His classification, in some instances, differs from those of the older writers, viz.: insidious iritis is designated as uveitis and serous iritis as cyclitis. In the chapter on sympathetic ophthalmia the statement is made that the sight of the exciting eye is lost, the chance of recovery of the sympathizing eye is much better if the exciting eye is promptly removed, There are still some authorities who will not accept this, but the writer has voiced the opinion of the more recent observers.

The lucid text and simplicity of expression of the chapter on diseases of the crystalline lens will carry the reader along with a

sense of pleasure. He will also derive equal satisfaction from the pages on “pupillary reactions." The average text book on ophthalmology deals with this very important subject in a manner anything but comprehensible and the student must go to the works on the anatomy of the nervous system or physiology where he immediately becomes confused.

The chapters on refraction are unimpeachable and while the practitioner of ophthalmology could readily understand and appreciate Dr. Jackson's methods, the beginner might find it difficult; yet there is nothing that would be obscure to or beyond the average oculist and the subject is treated wholly from a practical standpoint. Like all exponents of what may be termed the “ Philadelphia School of Refractionists,” he considers “Skiascopy;" or, according to Thorington, "Retinoscopy," the only accurate and infallible method of estimating astigmatic errors. A difficult method to master, it is here placed before the student simply and intelligently.

The newer drugs are mentioned in relation to their therapeutic application: Protargol in diplobacillus conjunctivitis, purulent conjunctivitis and obstruction of the nasal duct; and Cassaripe in suppurating ulcer of the cornea as used by Chandler and Risley.

The bibliography at the end of each chapter is a valuable adjunct and furnishes the student with a broad field for study and reference.

On the whole the author has written an excellent and very practical working volume and one which we can heartily recommend.

H. S. P.

Operative Surgery. By Joseph D. Bryant, M. D., Professor of the

Principles and Practice of Surgery, Operative and Clinical Surgery, University and Bellevue Hospital Medical College; Visiting Surgeon to Bellevue and St. Vincent's Hospitals; Consulting Surgeon to the Hospital for Ruptured and Crippled, Woman's Hospital, and Manhattan State Hospital for the Insane; Fellow of the American Medical Association; former President of the New York Academy of Medicine; President of the New York State Medical Association, etc. Vol. I. General Principles, Anæsthetics, Antiseptics, Control of Hæmorrhage. Treatment of Operation Wounds, Ligature of Arteries. Operations on Veins, Capillaries, Nervous System, Tendons, Ligaments, Fasciæ, Muscles, Bursæ and Bones. Amputations, Deformities. Plastic Surgery. This volume contains seven hundred and forty-nine illustrations, fifty of which are colored.

New York: D. Appleton & Company, 1899. This is the third edition of Dr. Bryant's well-known work, although the fact is not stated upon the title page. Readers of the first edition, who were disappointed that such a promising text should have been marred by the printer, will be gratified that the author has seen fit to rescue his book, and has in the two succeeding editions not only remodelled but has enlarged and modernized it, so that now it represents the best thought upon operative surgery and takes rank among the most practical treatises upon the subject in the English language. The peculiar feature of the book which entitles it to this high praise is the fidelity with which the consecutive steps of operations are described from the primary anatomical considerations throughout the details of the technique.

The first three chapters, covering one hundred pages, treat of the paraphernalia and preparations for operations, including instruments, anæsthesia, the arrest of hæmorrhage and the management of operation wounds. These chapters constitute a general introduction which is terminated by a short consideration of emergencies, the precautions against them and the treatment of the more common accidents, as shock and air in the veins. As an essential requirement of operations, the author regards as the most important, “a knowledge of the results of the operation to be performed as modified by the patient's condition and the em

emergencies liable to occur."

Chapter IV is devoted to the ligature of arteries. After discussion of the general considerations, the operations for ligating the special arteries are described in detail. The method used by the author includes (1) the points accessible, (2) the contiguous anatomy and the “guides" (linear, muscular, bony, contiguous anatomical, pulsation and color of the vessels), (3) the methods, (4) the operation, (5) the results, (6) the dangers, and (7)

the fallacies. Alexander's operation of ligating the vertebral for the relief of epilepsy is included, the permanent benefit in the cases operated being too slight to warrant its continuance.

Chapter V upon operations on veins and capillaries includes ligation, operations for varicose veins, venesection and transfusion. Chapter VI is an especially complete and accurate treatise upon operations on the nervous system. The author favors the removal of the bullet in gunshot wounds of the brain, and illustrates his simple and ingenious method of locating the site of counter-opening. The cases tabulated by him in 1888 make a distinct showing in favor of the removal, as do the sixty cases reported by Fowler, the latter having a mortality of sixteen per cent following extraction, and of fifty-nine per cent in the non-operated cases. In Chapter VII are comprised the operations on tendons, ligaments, fascias, muscles and bursæ. Chapter VIII includes operations on bones; Chapter IX, amputations; Chapter X, deformities, brisement forcé, spinal curvature, wry-neck and deformities of the extremities; the volume concluding with Chapter XII on plastic surgery.

Current medical Literature


Edited by Samuel B. Ward, M. D. The Diagnosis of Tumor of the Lungs.- By Dr. HELLENDALL (Zeit. für klin. Med., Bd. 37, Hft. 5 und 6). The writer reports three cases of tumor of the lungs. The first case was one of six years' duration and had been for a long time considered one of pulmonary tuberculosis, and next as a case of heart disease. A positive diagnosis was finally made by aspiration of the tumor and examination of a few flocculi of tissue obtained. At autopsy the case was found to be one of primary round cell sarcoma of the lung. The second was one of rapid character. A few weeks after the removal of a fibro-myxo-sarcoma from one buttock, patient had what appeared to be a typical attack of lobar pneumonia, with crisis. More or less fever, however, followed the crisis and as signs persisted in the right lung the case was supposed to be one of post-pneumonic phthisis, though no tubercle bacilli were found. Aspiration of the lung was practiced and a few flocculi of tissue obtained and diagnosis of sarcoma made which was confirmed at autopsy. The third case was one treated at first for hemorrhagic pleurisy. Later, consolidation of the lung developed and aspiration was practiced. From the flocculi of tissue obtained a diagnosis of sarcoma was made. At autopsy the patient was found to have a primary carcinoma of the stomach with metastases to the pleura, ribs, peritoneum, gall bladder, urinary bladder and rectum. Authors have not heretofore considered aspiration of solid tumors of much value but the results of these cases lead the writer to strongly recommend it in suspected pulmonary tumors, for he believes that in most cases a few flocculi of the tumor substance can be obtained.

Intestinal Lithiasis.— Milian and CHEVALLIER in the Gazette des Hopitaux for November 18, 1899, gave a complete historical, clinical and pathological review of this interesting subject. They refer in their article to the calculi formed in the intestine itself from its secretions and not to intestinal calculi originating in other parts of the body In speaking of the etiology of the calculi they state that it is essentially a disease of middle life, the majority of the cases occurring between 40 and 50. Women are attacked about twice as often as men, and the disease occurs as a rule in individuals with a tendency to arthritic and intestinal disturbances. With regard to the symptoms they state that intestinal lithiasis never comes on as a primary disease. It is always preceded by disturbances of the alimentary tract, particularly by muco-membranous enteritis.

The symptoms of the lithiasis itself consist of intestinal disturbances in the form of constipation and of severe attacks of intestinal colic. The attacks of colic are accompanied by vomiting, hiccough and sensations of vertigo and disappear after the evacuation of the intestinal sand which characterizes the disease and which may or may not be mixed with actual stone. During these attacks the abdomen is generally swollen and sensitive to pressure, but there is not the exquisite sensitiveness, such as is seen in peritonitis or appendicitis. This tenderness is apt to occur over the colon. During the evacuation of the bowels preceding the stoppage of the pain, the patient has the sensation of passing large quantities of soil. Between the attacks the symptoms are those of muco-membranous enteritis.

The intestinal concretions are in the form of sand, gravel or actual stones. The sand is of a brownish or yellowish color and may attain to a considerable quantity; the gravel is generally in particles the size of pepper seeds. The stones can attain the size of a pigeon's egg or even that of a hen's egg. They do not show, except rarely, concentric layers like a gall stone. They are mainly made up of organic material and triple phosphates.

With regard to the pathogenesis of the condition it may be said that intestinal lithiasis is observed especially in neuro-arthritics; it is caused directly by chronic intestinal inflammation in the form of muco-membranous enteritis, the remains of typ fever or some other inflammatory lesion. This chronic inflammation is kept up by the improper habits of the patient, too rigid a vegetarian diet and habitual constipation. The accumulation of sand is favored by intestinal atony and constipation. With regard to the diagnosis the authors lay stress on the association of chronic colitis with painful and intestinal crises and the examination of the stools for sand. The treatment is dietetic and laxative. Potatoes and meat extractives should especially be avoided as they contain potash.

Strict Milk Diet in Diabetes Mellitus.- WINTERNITZ and STRASSER in the Centralblatt für innere Medicin, 1899, No. 45, called attention to the value of the milk diet in diabetes, a treatment recommended years ago by Donkin and advocated by Winternitz, who has repeatedly stated its great service in the different forms of diabetes. Their conclusions are:

1. A strict milk diet will, in a short time, often after forty-eight hours, render the majority of diabetics free from sugar or reduce most markedly the excretion of sugar.

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