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 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.

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 typhoid 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.

2. This is true for those in early life who have usually a severe form of diabetes as well as those who are very adipose or where the diabetes follows injury or shock. Cases which by strict diabetic diet and after a Carlsbad cure have not been entirely free from sugar, show, after a strict milk diet, a further diminution or even complete disappearance of the sugar.

3. In diabetes associated with albuminuria and nephritis, the albuminuria diminishes and in some cases disappears shortly after the disappearance of the sugar.

4. In many cases by strict milk diet after disappearance or diminution of the glycosuria, aceton occurs in the urine or when previously present is increased.

5. In many cases, by the change from the milk cure to a mixed diet, the sugar which has entirely disappeared recurs in greater or less quantity. The renewal of the strict milk cure again induces a complete disappearance.

6. In the passage from a strict milk diet to a mixed diet, it has not yet been with certainty determined if green vegetables and cereals are not to be preferred to meats.

7. Some cases are entirely healed by the milk cure and remain well with a mixed diet containing an abundance of starches.

8. In most cases there is in the beginning a slight decrease in the body weight, but in a short time it remains stationary and even an increase in weight may follow.

The Effects of Influenza upon the Heart.-Sansom, in the International Medical Journal, November, 1899, considers from his large personal experience this subject. An abnormal excitation of the heart occurs as a frequent sequel of influenza. It may be persistent for long periods or intermittent and accompanied by other symptoms of palpitation. It may occur with the initial infection or begin some weeks or months after the original attack. In the majority of the cases there was little or no discomfort, while in some the phenomena associated with Graves' disease were present. There was no evidence that in these cases there was any structural disease of the heart other than dilatation, and dilatation is comparatively rare. There was no relation between rate of acceleration and evidence of dilatation The dilatation is due to an affection of the nervous mechanism. Irregularity of the heart is observed very commonly after influenza, but there is no sort of proportion between the degree of irregularity and the subjective symptoms of the patients. Therefore, the attention of the patient should be taken from his heart as much as possible. In post-influenzal Graves' disease there may be irregularity of the heart instead of rapidity or as well as rapidity. In some cases there is a disturbance of hearing or auditory vertigo and the removal of any reflex disturbance of the nasal auditory mechanism has been of value. In the gouty the symptoms have been serious, severe, cardiac pain, distress, and even heart failure. There may be an abnormal retardation of the heart's action, paroxysmal or continuous, after influenza. The rate has been as low as nineteen and the danger to life has been greater relatively than in

tachycardia and arrhythmia. Pain was at times very severe, but the chief danger was from syncope. In some cases there may be a cardialgia similar to angina, but without high arterial tension. These cases were not fatal and the condition seemed to be a neuritis or a visceral neuralgia and not a true angina. They differ from the acute cases of simulated angina in the following particulars: (1) The severe pain is brought about or aggravated by very slight movements or exertion. (2) There is a peculiar "dead leaf” hue of the countenance and a more marked facies Hippocratica. (3) Though there is not persistent high arterial tension, the radial is found to become contracted and narrow during a heart attack.

NEUROLOGY

Edited by Henry Hun, M. D.

Investigations Upon the Electrical Excitability of the Corpora Quadrigemina.- PRUS (Wiener klin. Wochensch., No. 45, 1899,) reviews the literature of experimental researches into the functions of the corpora quadrigemina, and publishes the results of investigations conducted by himself upon dogs. The induced current was employed and observations were made upon the motor phenomena, and the conditions of the blood pressure, respiration, secretion and the cerebral activities. Stimulation of the anterior quadrigemina induced tonic spasms, peculiar movements of the limbs as in walking or swimming, epileptic attacks, with movements of the head, ears, tail, eyes or iris, and frequently swallowing movements; secretion of saliva, sneezing and emotional states; respiration ceased during the continuance of the irritation, and afterward was slow, with deep inspiration; the blood pressure was elevated and the pulse rate was retarded. In order to exclude reflex action from these results Prus applied cocaine to the surface of the parts under examination, and found that stimulation of the anesthetized structures failed to produce the changes in locomotion, the epileptic attacks, retardation of the respiration, and of the pulse rate, increase in blood pressure and secretion of saliva, sneezing and emotional results. There remain then, as functions of the anterior quadrigemina, tonic cramps, movements of the head, eyes, pupils, ears, and acts of swallowing.

Stimulation of the posterior qundrigemina was followed by clonic spasms, walking movements, dilatation of the pupils, acceleration of respiration and puise, manifestations of terror, barking, lifting of the head, turning of the eyes to the opposite side, nystagmus and exophthalmos, increased blood pressure, and secretion of saliva, contractions of the cardia and epileptic attacks. After the application of cocaine the results of the stimulation were limited to clonic spasms, elevation of the head, turning of the eyes to the opposite side, dilatation of the pupils, exophthalmos, contractions of the cardia and barking.

The results of all information up to the present time show that (1) in the anterior quadrigemina exist motor centres, the principal effect of the irritation of which produce optic results, while the principal effects of irritation of the posterior quadrigemina are manifested in acoustic effects;