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with the biology of bacteria, paying special attention to their chemistry and to the effects of the different agents which can be used for their destruction. He also takes up in this portion of the book the questions of immunity and infection, the question of the use of animals for diagnostic and test purposes, and the questions of the procuring of material from patients and of the examination of water and air. The remainder of the book is devoted to the discussion of specific bacteria. As an appendix the author has inserted brief descriptions of some of the pathogenic microorganisms which are not usually included under the heading of bacteria. Finally after this appendix there is a short index of infectious diseases with their bacterial causative agents.

The book in its entirety is quite satisfactory, and gives a fair and impartial digest of the ground it covers, besides bringing in both published and unpublished work of the author and his laboratory associates.

The chief fault which we have to find with the volume is that it gives evidence either of hasty preparation or of very careless proof reading. In numerous places proper names of well-known investigators are improperly spelt. Thus, Birch-Hirschfeld is spoken of as “Birsch-Hirschfeld;" Hansen, the discoverer of the leprosy bacilli, is spoken of as “ Hausen;" Barbacci is spoken of as Barhacci" and Charrin is spoken of as • Chassin." There are a number of other similar mistakes chiefly in connection with the names of foreign writers.

Besides these mistakes in names the text at times shows carelessness in its construction. For example the sentence: “This bacillus is pathogenic for rats, mice, guinea-pigs, monkeys, rabbits, flies, and other insects, which usually die within two or three days after inoculation,” is open to a construction which the author certainly did not mean it to have. There are other instances of this kind in the book.

There are a few statements made by the author which we think are open to criticism. For example, in the section under tuberculosis the author speaks as though authentic instances of tuberculosis in the new born child had not been proved, while as a matter of fact there are a number of undoubted cases in the literature. And again, the same remark may be made in connection with placental tuberculosis. In the section on typhoid fever the author makes the statement that in this disease necrosis of the tissues of the internal organs is a comparatively rare occurrence, and that caseation of the mesenteric glands, which is commonly observed, is due probably to mixed infection. We think that few observers who have studied their typhoid autopsies, both pathologically and bacteriologically, will agree with either of these statements. In this same chapter the following sentence occurs in connection with suppuration following typhoid fever. • Such cases, however, are of comparatively rare occurrence, because only exceptionally do the bacilli sufficiently mass together in such numbers as to become pus producers.” This would give the impression that the production of pus was due to the massing together of the bacilli, which is hardly, we think, what the author means to suggest. Other examples of more or less involved sentences could be quoted, although the number present in the book is not large. Another point in which the author makes a mis-statement is in regard to the bacillus aërogenes capsulatus. He states of this organism that it does not produce spores, while Dunham showed that the organism does produce spores on blood serum, and this statement was confirmed by Welch. In speaking of the staphylococcus pyogenes aureus we wonder that the author did not mention its growth on potato, as the most characteristic pigment formation occurs on this medium. In connection with the proteus vulgaris the growth on potato is also omitted, although on this medium the organism gives rise to its characteristic trimethylamine smell. The author omits mentioning the para-colon group of bacilli, and under the heading of Friedlander's bacillus, does not mention similar organisms described by Pfeiffer and Wright.

The index of infectious diseases at the end of the volume would be more useful if more comprehensive. The statement regarding appendicitis would indicate that it is generally due to the bacillus coli communis, a statement with which but few careful bacteriologists will agree.

The book in places shows evidences of careless book-making. For example, one of the chapters has a superfluous “the” in the heading, and the descriptions beneath the plate opposite page 264 do not describe the appearances seen in the two lower fields of the plate. With the correction of these few minor errors and more careful proof-reading, we think that the book would usefully fulfill the purpose for which it is intended.

We regret to observe that some of the illustrations of apparatus in the early part of the book are labeled with the makers' names. This savors too much of commercialism, which is unfortunately already a stench in the nostrils of the medical profession.

G. B.

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The International Medical Annual and Practitioners' Index: A Work

of Reference for Medical Practitioners. By Forty-Two Contributors. Eighteenth Volume. New York and Chicago: E. B. Treat & Co.

Pp. 748. Price, $3. The eighteenth volume of this well known annual comes each year as a welcome addition to the every day consulting library of the physician. Its value consists in the practical and useful character of its references. The latest scientific theories are considered as well as the most approved lines of treatment for special conditions. The latest theories in regard to the ætiology of cancer and malaria are fully discussed, while that bane of medicine, the treatment of rheumatism, receives for its consideration eight pages. The inflammations of the accessory sinuses of the nose are well illustrated and fully covered. Each year one subject receives especial prominence and in this volume the consideration of the diseases of the stomach, their medical and surgical treatment, has this place of honor. The unusual disease mycetoma, a condition similar to actinomycosis and usually affecting the feet, is made very easily recognizable by three colored plates.

The volume has in addition a review of the latest therapeutics, a chapter upon Radiography, the year's work in sanitary science, and an abstract of the legal decisions affecting medical practitioners and the public health.


Current Medical Literature


Edited by A. Vander Veer, M. D.

The Radical Operation for Varicocele.- ALBERT NARATH (Wiener klinische Wochenscrift, 25 January, 1900) has performed the operation in several cases in the following manner: An incision through the skin, about ten centimetres in length, is made in the direction of the inguinal canal, about a finger breadth above Poupart's ligament. This incision, which is not carried as far down as the tuberculum pubis, is carried through the skin and superficial fascia. The external oblique muscle is then split in the same direction and the inguinal canal laid open in its whole extent, just as in Bassini's operation for inguinal hernia. The spermatic cord with the cremaster ani the tunica vaginalis is then lifted out of the inguinal caral, this being very easily accomplished. With a short longitudinal cut, or finger dissection, to separate the cremaster and the tunic, the whole outline of the spermatic cord is brought into clear view. The distended veins are exposed even when only slightly filled in the inguinal canal access is given either to the main trunk of the internal spermatic vein or its principal branches. The veins are dissected out as far as possible, tied with double ligatures and separated between the ligatures. The proximal stump of the incised vessels immediately retracts and disappears, as they lie higher than the internal ring. The distal veins are then traced as far as the externa! ring, and likewise separated between two ligatures. In this way a section of several centimetres in length is removed from the venous trunks and their branches, or, in high origin of the latter, from them alone. The veins are very easily separated from their relations with the spermatic cord. Following the operation care must be taken to prevent a peritoneal hernia. If this be present it must be isolated, twisted, ligated and amputated. Finally the external spermatic veins may be investigated, and if dilated, should be also resected. As the last act of the operation the inguinal canal should be closed after the manner practiced by Bassini.

The aavartages of this operation may be summarized as follows:

(1) The initial incision is made in a region which may be much more easily cleansed and sterilized than the scrotum; (2) the circulation in the internal spermatic vein is completely interrupted and the high pressure relieved; (s) the chance of wounding the internal spermatic artery is much more reduced than in any other operation; (4) if the external spermatic veins are in perceptible degree distended they may also be resected; (5) an inguinal hernia, when it exists, may be treated at the same time. Small peritoneal herniæ may also be found for the first time by the opening of the inguinal canal; their recovery is easy; (6) lipomata presenting may also be removed at once; (7) the inguinal canal may be firmly closed; (8) the spermatic cord may be drawn forward and embedded in a narrow canal; (9) the testicles are made to lie higher, and the absolule length of the extra-abdominal scrotum is reduced, so that the column of the pendent blood vessels is reduced; (10) the influence of the abdominal pressure upon the circulation in the testicle is reduced or entirely relieved; (11) the collateral circulation in the scrotum remains inasmuch as the scrotum itself has not been operisted ur:on; (12) the operation is very neat and aseptic, the venous plexus remains intact, and the loss of blood is very slight.


Surgical Treatment of Carcinoma of the Stomach.-By Dr. H. L'INDNER Berl, klin. Woch., January 29, 1900. Billroth was the first to demonstrate that large pieces of a carcinomatous stomach could be removed with

Tnere appeared, however, to be comparatively few cases in which such an operation was practicable, and its place was largely taken by gastro-enterostomy which was first recommended by Wolfler. During the past two years the surgery of the stomach has come into special notice. and particularly the surgery of carcinoma of the stomach. At present there appear to be three important questions with regard to this matter: (1st.) Is it possible to remove a carcinoma of the stomach in a more radical fashion than formerly? (2d) Is it better in cases in which a radical operation is impossible to perform a total resection of the stomach, or to perform a gastro-enterostomy? (30.) In cases in which only a palliative operation is possible is gastro-enterostomy to be preferred to jejunostomy?

In regard to the first question the necessity of removing lymphatic glands and vessels connected with the stomach must be borne in mind There are four groups of glands which are of special importance in carcinoma of the stomach; (ist.) the group in the ligamentum gastrocolicum; (2d.) the group in the ligamentum gastro-hepaticum; (3d.) the group in the bend of the duodenum; (4th.) the group about the choledochus and the portal vein.

The results of operation would appear to show that recurrences are more apt to occur in the stomach or duodenum than in the glands. In twentyeight cases of resection of a portion of the stomach with autopsy there was local recurrence in fifteen, distinct recurrence in twelve, and gland recurrence in one. The writer «specially emphasizes the necessity of the appreciation on the part of the internists of the value of an early diag. nosis if operation is to be successfully performed.

In regard to the question as to whether a total resection is to be preferred to gastro-enterostomy in cases in which it is impossible to remove all of the carcinomatous growth, the writer is inclined to consider gastroenterostomy the operation to be preferred, and in general it appears to give more relief from the distressing symptoms. The writer usually prefers ante-colic gastro-enterostomy, associated with entero-anastomosis between the duodenum and jejunum, thus preventing the bile and pancreatic fluid from gaining access to the stomach. Maydl has been the chief advocate of the jejunostomy and Maydl's statistics are very satisfactory, but both theoretically and practically the writer feels that this operation is not so satisfactory as is gastro-enterostomy, for it does not provide for the relief of an obstructed yylorus if such should exist.

Operative Treatment of a Fibroma of the Mesentery with Extensive Resection of the Intestine.-By Dr. E. LEXER. Berl. klin. Woch., January 1, 1900. The mortality following operations for the removal of large tumors of the mesentery is necessarily high. Shock and peritonitis seem to be the chief cause; of death. Peritonitis usually comes from gangrene of the anastomosed ends of the intestine, due to an insufficient blood supply.

The writer reports a case of a man of forty-one years, in whose abdomen there existed a large movable tumor situated below the umbilicus, and occupying the mid region of the abdomen. It did not cause the patient a great deal of discomfort aside from a colicky pain and a dragging sensation. At operation the tumor was found to be situated between the two layers of the mesentery, and along the convexity of the tumor ran a coil of ileum between which, and the tumor there were two or three centimetres of mesentery. At the base of attachment of the tumor there were situated some large branches of the mesenteric artery and vein, which it was necessary to ligate. This necessitated the removal of all the intestine supplied by these branches, and accordingly two metres of the ileum were removed along with the tumor. There was no involvement of the lymphatic glands. The writer performed a lateral anastomosis of the resected ends of the intestine and the abdomen was closed The patient made an uninterrupted recovery. Microscopic examination of the tumor, which weighed five pounds, showed it to be a fibroma with small areas of myxomatous tissue. The writer refers to several cases of successful resections of large portions of the intestine, and says that the longest piece ever successfully removed was three metres and thirty centimetres, done by Ruggi in 1894. Montprofit has recently successfully removed a piece of intestine three metres and ten centimetres in length.


Edited by Samuel B. Ward, M. D. Heredity in Chronic Nephritis.—By Dr. P. K. Pel. (Zeit. Für. klin. Med., Bd 38, Hft. 1, 2, 3.) In studying the hereditary character of a disease, one should not only consider the frequency with which it occurs but should also pay especial attention to the conditions under which the hereditary tendency seems to manifest itself. The writer calls attention to the generally accepted hereditary tendencies in certain diseases, as hæmophilia, optic atrophy, and the so called diseases of metabolism, as gout, diabetes and obesity. In tuberculosis, nervous diseases, migraiue, heart diseases, arteriosclerosis and lithiasis, hereditary tendencies are clearly proved to exist. The writer also states that in from ten to fifteen per cent. of cases of cancer there is an hereditary element.

With regard to chronic nephritis, there does not appear to exist any very strong sentiment that heredity plays a roll of any special importance. The writer bas carefully gone over the literature and quotes from most of the more prominent writers on diseases of the kidney. With considerable accord they recognize the possibility of an hereditary tendency, but say that it is not clearly proved. A few writers are more positive in the statement that

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