July, 1909

be between forty-five and fifty and gives an account of marked recent neurasthenia without very obvious cause-if these be inquired into, light as to the basic interstitial hyperplasia, and as to the probable kidney condition and the dangers predictable therefrom, will rather certainly be had, and the way be thus made clearer for prognosis and treatment.

Often in these conditions it must perhaps remain impossible to differentiate between arteriosclerosis and plebosclerosis, and the resulting arteritis and thrombosis. One thing should not be overlooked, although its importance as a diagnostic help is suggestive rather than conclusive, especially in chronic interstitial nephritis; namely, that there is often, (as Lion, Zeisch. f. Klin. Med., Vol. 50, has shown so markedly), an exaggerated Patellar reflex, which, increasing as the intoxication become more severe, becomes later so significant that when discovered suspicion of the asic disease and of the kidney degeneration becomes more legitimate than perhaps elsewise.

As to the major late nervous symptoms of chronic interstitial nephritis, they all may be chiefly attributed to the completer breaking down and inefficiency of the vascular system and the development of thrombi and emboli in different localities. In the brain, local or more general vascular lesions, giving rise to sensory troubles in the eyes or ears, and to motor troubles in the various muscular muscular spheres, are common. Uremic convulsions or successive paralytic attacks affirm in turn the extent to which degeneration has progressed. Often, however, these, or any other severe symptoms, do not occur until after the aurist or the ophthalmologist finds indisputable evidence in his special investigations. Probably quite a proportion of cases of tinnitus and even of deafness, that are usually attributed to catarrhal changes, belong to the category of artericsclerotic or interstitial changes. In this field as yet but little seems to have been differentiated. In the eye, however, very definite manifestations are already known in connection with these basic conditions, and sometimes the evidence thus gleaned is simply invaluable.

Indeed, among the very first appreciable symptoms at all, may be the flame-shaped retinal hemorrhages, or the diffused retinitis, or the pupillitis, or the uremic amaurosis so startlingly sudden, which needs the ophthalmoscope for discovery and differentiation. Twenty years ago Gowers declared every practitioner should know how to use the ophthalmoscope; and in connection with the diagnosis of chronic interstitial nephritis, or of vascular sclerosis, one cannot see how the general practitioner can very well get along without it. These conditions when marked are very plain, and discoverable by anyone who knows how to observe the interior of

the eye. Earlier than these, however, and if accurately determined, very suggestive, to say the least, are certain other changes sometimes noticed in the retinal blood-vessels, and at the margin of the disc. Indeed, I should not wonder if it turned out that certain narrowings of the retinal arteries, certain distensions of the retinal veins, and certain partial obscurations of the pupillar margin, which may be noticed when there is no characteristic arterial crinkling present, will be found to point at least suggestively to possible degenerative changes. If we can only learn to do it, it seems to me that here is a field for early recognition of interstitial changes, which will enable the discoverer both to warn the patient and to prescribe for the condition, in time, possibly, to be of some use. So far as the sudden blindness of uremia is concerned, every such case should be as promptly differentiated from other possible conditions entirely remote from that under consideration as possible.

Evidently as the nephritis and the basic condition become more permanent, difficulties of diagnosis often disappear proportionally. Often, of course, the case is not seen until transient hemiplegia or monoplegia, or aphasia, or frequent and marked vertigo, or the Stokes-Adams syndrome consisting of vertigo, slow pulse, and syncopal or epileptic attacks, hasten the sufferer to seek advice and help. Often, too, the hour of apoplexy or of uremic convulsions is awaited. Here the determination of gross heart lesions, and if practicable of casts and albumen, with a previous history of increased quantities of pail urine of low specific gravity makes the explanation of previous minor nervous symptoms easy. And in this connection, and in fact all along, what Leszynsky (Med. Rec., May 20, 1905) has so emphatically said, should be remembered: "In making the diagnosis of chronic nephritis in a doubtful case it is more essential to consider the amount of urine secreted every twenty-four hours, its specific gravity, and the amount of urea or solids therein contained than to lay stress on the presence of a trace or more of albumin and a few hyalin casts."

Another bit of skill we have serious need of too is that which will enable us to appreciate vascular hypertension, or hypotension of slight degrees much more accurately than now, and also their real significance when found. The recent studies of Rotch (Jour. Am. Med. Asso., Oct. 10, 1908), respecting the "anatomic age" of children, as contra-distinguished from their "chronologic age," suggests the possibility of likewise determining the real age all along, by degrees of tissue involution, rather than by years as we now do.

To sum up, then, first, the almost constant relation between intestinal putrefaction, arteriosclerosis and chronic interstitial nephritis is the primary fact to be borne in mind; no matter

whether the symptoms be chiefly nervous or otherwise; and it matters little, too, whether we believe the nephritis or the arterial degeneration comes first, or whether both be expressions of some underlying systemic fault, an idea that has the support of Minot, and has many everyday observations that sustain it strongly. Probably in most instances they are such close twins that their existence is practically inseparable.

Second, with this toxemia and vascular degeneration both effective in the brain and cord, it is not surprising that we may note a rather long series of symptoms which may legitimately be called nervous:

Headache, variable, even unto true migraine;
Sleeplessness, or somnolence;

Head distresses of all sorts (paresthesia);
Neuralgic pains anywhere;

Numbness, etc.;

Indigestion and vomiting;

Muscular twitching, and spasm to convulsions;

Blindness, deafness, retinitis;
Transitory aphasia ;

Paresis or paralysis of face or extremity; Temporary or permanent hemiplegia, with or without aphasia;

Delirium, stupor, coma;
Insanity.

Third, the earlier nervous symptoms, save the occasional retinitis, although not particularly pathognomic, and valuable chiefly as suggestive forewarnings, still, when the patient is fifty years old, in this age of strenuous and irregular life, with all sorts of climatic, industrial, domestic and individual trauma to shock and exhaust, the possibility of underlying interstitial nephritis should have its weight always.

Fourth, cases of inexplicable neuralgic pains or paresthesia, not bounded by definite nerve tracts; or disagreeable neck and head feelings in the morning, turning later into definite headache, which interferes with timely dropping asleep; or fatigue neurosis, recently developed; or mental pain and weakness, and nervousness, all slowly developed, and variable in expression; or of irritable muscular activities, either manifest generally or more especially in the heart; various and repeated crises in all the vascular sphere, and in various organs, and often these concomitant with corresponding nervous and mental crises; these, even if the urine reveals little or nothing, should arouse the suspicion that neuro-fibrosis is developing, and that nephritic or hepatic or gastric or any other localized interstitial hardening is imminent.

Fifth, all these overlooked or past, then the occurrence of cardiac hypertrophy, hardened. arteries, sudden blindness, suddenly affected hearing, inexplicable faintings, dyspnea, con

JOURNAL OF MEDICINE

Several press reports of my paper on Congregational Practice, read by title before the American Academy of Medicine, tend to convey the idea that I favor the ordinary form of contract practice. Without anticipating the publication of the paper, I may say that it proposes a much broader scope of professional service, which could be put into execution only by a gradual development of professional and public opinion, the basis of payment being only one of the details. Ordinary contract practice starts with a false conception of the value of services and usually involves bad faith both as to demand and fulfillment. Very truly yours,

NOTICE.

A. L. BENEDICT.

The Medical Board of St. John's Hospital, Brooklyn, N. Y., desires to announce that the position of Visiting Anæsthetist is vacant. Applications for same should be directed to Frank Henry Knight, Secretary of the Medical Board, St. John's Hospital, corner of Albany and Atlantic Avenues, Brooklyn, N. Y.

COUNTY SOCIETIES.

CHENANGO COUNTY MEDICAL SOCIETY. ONE HUNDRED AND FOURTH SEMI-ANNUAL MEETING HELD AT AFTON, JUNE 8, 1909. PROGRAM.

"A Case of Pneumonia," A. H. Evans. "Insanity Due to Dental Lesions," C. M. Dunne, D.D.S.

"The Aid of a Laboratory in Country Practice," E. Danforth.

"Bier's Hyperemic Treatment," P. B. Brooks.

MEDICAL SOCIETY OF THE COUNTY OF CHAUTAUQUA.

TRI-ANNUAL MEETING TUESDAY, MAY 25, 1909, AT FREDONIA.

"Eclampsia," Ellis W. Storms.

"Some of the Causes of Constipation in Children," G. E. Smith.

"Some Things We Ought Not to Say or Do," E. M.. Scofield.

"Minor Pelvic Ailments," J. L. Greeley.

RICHMOND COUNTY MEDICAL SOCIETY. REGULAR MEETING HELD IN THE STATEN ISLAND ACADEMY, JUNE 9, 1909.

Interesting Spinal Cases, illustrated with photographs, Sigmund Epstein.

After the meeting a very enjoyable collation was. served.

MEDICAL SOCIETY OF THE COUNTY OF COLUMBIA.

SEMI-ANNUAL MEETING, CHATHAM, MAY 11, 1909. A committee was appointed to draft resolutions of condolence on the deaths of Drs. John T. Wheeler, of Chatham, and F. T. Kunker, of North Chatham.

SCIENTIFIC SESSION.

A Symposium on Syphilis.

"Etiology," T. S. Van Riempst, New York. Address and Pathological Demonstration with Special Reference to Microscopical Findings. Discussion opened by Y. F. Dunning.

Prognosis and Treatment Louis Van Hosen, Hudson. Discussion opened by I. C. Washburn.

The next meeting of the Society will be held in Hudson, October 5th, in conjunction with the Third District Branch, at which time an address will be given by Dr. Hortense V. Bruce, Superintendent of the New York Training School for Girls at the Institution, on "The Juvenile Delinquent." The members of the Society have been invited by the Managers of the Institution to a luncheon at 1 o'clock and to inspect the buildings and methods employed there. A scientific program will follow in the New Court House at 2 o'clock. At 5 o'clock a fitting tribute will be paid to the late Dr. John T. Wheeler, who was, at the time of his death, First Vice-President of the Medical Society of the State of New York and an active memger of the Medical Society of the County of Columbia.

'MEDICAL SOCIETY OF THE COUNTY OF SCHENECTADY.

REGULAR SEMI-ANNUAL MEETING, SARATOGA LAKE, JUNE 16, 1909.

"Movable Kidney," William P. Faust.

MEDICAL SOCIETY OF THE COUNTY OF MONROE.

REGULAR MEETING HELD AT ROCHESTER, MAY 18, 1909. "Surgery of ae Kidney," E. W. Mulligan. Discussion: F. W. Zimmer and C. R. Barber. "Recent Progress in the Treatment of Gout," E. P. Joslin, Boston.

Discussion: C. G. Stockton. "Sciatic Pain," R. R. Fitch. Discussion: E. B. Angell.

"Fresh Air Treatment of Surgical Tuberculosis," Brainard Whitbeck, New York.

Discussion: J. R. Culkin.

"The New Sanitation," Prof. C. W. Dodge. Discussions: Quarantine of Small-pox, G. W. Goler. Quarantine of Advanced Pulmonary Tuberculosis, W. S. Ely.

"Psychoses Occurring During Pregnancy and the Puerperium," E. P. Ballantine.

Discussion: W. J. Herriman and W. M. Brown.
A very enjoyable dinner was served at 1 o'clock.
MEDICAL SOCIETY OF THE COUNTY OF
TOMPKINS.

REGULAR MEETING HELD JUNE 15, 1909.
PROGRAM.

"Rabies-The Present Method of Its Diagnosis," V. A. Moore.

MEDICAL SOCIETY OF THE COUNTY OF FRANKLIN.

SEMI-ANNUAL MEETING AT SARANAC LAKE, JUNE 8, 1909. PROGRAM.

Business Session.

The meeting of the Comitia Minora was held at 1.30. The regular Society was called to order at 2 P. M. There was a full attendance.

The following candidates were nominated for officers for 1910: President, E. R. Baldwin, of Saranac Lake;

Vice-President, A. H. Garvin, of Ray Brook; Secretary-Treasurer, G. M. Abbott, of Saranac Lake; Delegate to Medical Society of the State of New York, G. M. Abbott; Delegate to Fourth District Branch, A. E. Moody. Two new members were elected.

Dr. McClellan, Chairman of the Franklin County Milk Commission, reported that a bulletin has been prepared to be sent to all the dairymen supplying milk in Franklin County. Dr. D. C. Twichell read the bulletin.

Scientific Session.

"Surgical Tuberculosis," C. C. Trembley.
"Tuberculosis of the Ear," A. A. La Vigne.

"Report of Two Cases of Pneumothorax," A. H. Allen.

"Uterine Fibroid," A. E. Moody.

BOOKS RECEIVED.

Acknowledgment of all books received will be made in this column and this will be deemed by us a full equivalent to those sending them. A selection from these volumes will be made for review, as dictated by their merits, or in the interests of our readers.

All books for review should be sent to the business office of the Medical Society of the State of New York, 17 West Fortythird Street, New York.

DIET IN HEALth and Disease. By Julius Friedenwald, M.D., Professor of Gastro-Enterology, College of Physicans and Surgeons, Baltimore, and John Ruhräh, M.D., Professor Diseases of Children, College of Physicians and Surgeons, Baltimore. Third edition, thoroughly revised and enlarged. Philadelphia and London, W. B. Saunders Company. 1909. MEDICAL INSPECTION OF SCHOOLS. By A. H. Hogarth, M.B., B.Ch., Oxon., D.P.H., County Medical Officer of Health for Buckinghamshire. Assistant Medical Officer (Education) London County Council. Medical Officer Mansion House Committee on the Dwellings of the Poor. London, Henry Frowde, Hodder & Stoughton, Oxford University Press, Warwick Square, E. C.

INBORN ERRORS OF METABOLISM. The Croonian Lectures delivered before the Royal Colleeg of Physicians of London, in June, 1908. By Archibald E. Garrod, D.M., M.A., Oxon. Fellow of the Royal College of Physicians. Assistant Physician to and Lecturer on Chemical Pathology at St. Bartholomew's Hospital. Physician to the Hospital for Sick Children, Great Ormond Street. London, Henry Frowde, Hodder & Stoughton, Oxford University Press, 20 Warwick Square, E. C.

INTERNATIONAL CLINICS. A Quarterly of Illustrated Clinical Lectures and especially prepared original articles by leading members of the medical profession throughout the world. Vol. II. Nineteenth Series, 1909. Philadelphia and London, J. B. Lippincott Company. 1909.

GRAPHIC METHODS IN HEART DISEASE. By John_Hay, M.D., M.R.C.P., Assistant Physician, Liverpool Royal Infirmary. With an introduction by James Mackenzie, M.D., M.R.C.P. London, Henry Frowde, Hodder & Stoughton, Oxford University Press, Warwick Square, E. C. 1909.

COMMON DISORDERS AND DISEASES OF CHILDREN. By George Frederic Still, M.A., M.D. (Cantab), F.R.C.P. (Lond.), Professor of Diseases of Children, King's College, London. Physician for Disease of Children, King's College Hospital. Physician to Out-Patients, Hospital for Sick Children, Great Ormond Street. Honorary Member of the American Pædiatric Society. London, Henry Frowde, Hodder & Stoughton, Oxford University Press, Warwick Square, E. C. 1909. STUDIES ON IMMUNITY. By Robert Muir, M.A., M.D., Professor of Pathology, University of Glasgow, in collaboration with Carl H. Browning, M.D., Alexan

der R. Ferguson, M.D., and William B. M. Martin, M.B., Ch.B. London, Henry Frowde, Hodder & Stoughton, Oxford University Press, Warwick Square, E. C. 1909.

SUTURE OF ARTERIES-An Experimental Research. By E. Archibald Smith, M.B., Ch.B., Victoria University, F.R.C.S., England. London, Henry Frowde, Hodder & Stoughton, Oxford University Press, Warwick Square, E. C. 1909.

MYOMATA OF THE UTERUS. By Howard A. Kelly, Professor of Gynecology in the Johns Hopkins University; Gynecologist-in-Chief to the Johns Hopkins. Hospital, and Thomas S. Cullen, Associate Professor of Gynecology, Johns Hopkins University; Associate Gynecologist to the Johns Hopkins Hospital. Illustrated by August Horn and Hermann Becker. Philadelphia and London, W. B. Saunders Company. 1909. Price: Cloth, $7.50 net.

TREATMENT OF THE DISEASES OF CHILDREN. By Charles Gilmore Kerley, Professor of Diseases of Children in the New York Polyclinic Medical School and Hospital; Attending Physician to the New York Infant Asylum and Maternity; Assistant Attending Physician to the Babies' Hospital; Consulting Physician to the Sevilla Home for Girls, and to the New York Home for Destitute and Crippled Children; Consulting Pediatrist to the Greenwich (Connecticut) Hospital. Second Edition, revised. Philadelphia and London, W. B. Saunders Company. 1909. Price: Cloth, $5.00 net. SMITHSONIAN INSTITUTION.

BUREAU OF AMERICAN ETHNOLOGY, Bulletin 34. PHYSICAL AND MEDICAL OBSERVATIONS among the Indians of Southwestern United States and Northern Mexico. By Aleš Hrdlička. Washington, Government Printing Office. 1908. LEGAL MEDICINE AND TOXICOLOGY. By R. L. Emerson, A.B., M.D. (Harvard), Member of the Massachusetts Medico-Legal Society; formerly Instructor in Physiological Chemistry, Harvard University Medical School, and Assistant in Clinical Pathology, Boston City Hospital. New York and London, D. Appleton and Company. 1909.

BOOK REVIEWS.

THE LAW IN GENERAL PRACTICE. Some Chapters in Every-day Forensic Medicine. By STANLEY B. ATKINSON, M.A., M.B., B.S3. London, H. Frowde, 1908. 230 pp. 12vo. Cloth, $3.00 net.

Being written by an Englishman for English practitioners, this book would appear at first sight to have less interest for Americans. It is not so, however, for there is much of interest, especially to one who cares to compare the methods of procedure in both countries. It contains a good deal of sound advice to every physician who may at any time come in contact with the law.

In the chapter on negligence in medical practice, no mention is made of different schools of medicine, though malpraxis and unqualified practice is discussed. In this country, or at least in some states of America, the practice of different schools governs to such a degree, that the treatment of a physician of one school must be tested only by the general doctrines, or no doctrines, of his own school, and not by those of other schools. (A. N. Taylor.) Shall we say "Happy England"?

Again, the liability of governors of a charitable hospital for negligence is an unsettled point in England, while the U. S. A. courts have decided that there is no such liability if a competent staff is employed. We are told, also, that the English law places no restraint nor limitations upon testimony, on the ground that such evidence was gained under the privileged circumstances of a medical adviser treating a patient. In about onehalf of the states in America the physician and patient

are protected, though in general this applies to civil cases only.

The decisions of some of the older judges seem strange to us and sometimes amusing. "If a physician or surgeon, even though not licensed, acting with due care gives his patient a potion or plaster, and contrary to expectations it kills him, this is neither murder nor manslaughter, but misadventure. For physic and salves were before licensed physicians and surgeons." (Lord Hale, 1675.) Throughout the book, the impression conveyed is, that the English are looking to ancient times for their authority, to a larger degree than we do in this country. PETER SCOTT.

ANGINA PECTORIS. Von Dr. LOUIS PEISER. Stuttgart, Verlag Von Ferdinand Enke. 1908.

It is not the author's intention to add a new theory on angina pectoris to the many already in existence. He has, however, made an exhaustive study of the best literature on this subject, and the manner in which he presents the collected material shows a great deal of thought, while his deductions suggest a man of sound and practical reasoning. He begins by citing a few typical and instructive cases of angina from his private practice and gives then a short historical sketch of this disease. Like the majority of modern writers, he accepts sclerosis of the coronaries as the principal etiological factor of true angina. Considerable space is allowed to arterio sclerosis, which he discusses in all its phases, and this leads to many repetitions when he arrives at the subject proper. There is one feature of angina which is extremely puzzling and has given rise to a great many theories-I mean the pain. The explanation offered by some writers and favored by Dr. Peiser, seems rather plausible to the reviewer. This pain, being simply a cramp-like spasm of the heart muscle, produced by ischæmra, may be compared to the pain of "intermittent claudication" found with arterio sclerosis of the lower extremities. Another puzzling fcature, the sudden death, is caused by the occlusion of a coronary artery. This is proven by animal experiment and on the autopsy table. When one of a dog's coronaries is clamped, the heart will come to a complete standstill in less than one minute. On the other hand, almost in every instance one of the coronary arteries is found practically occluded after death from angina. A complete and excellent picture of the predisposing factors and of the attack itself is presented and a differential diagnosis from the various forms of pseudo angina is offered. But the author himself confesses to the great difficulty of a positive diagnosis during life, because there is not one single symptom of angina vera which may not be found with other conditions.

The chapter on treatment suggests hardly anything new, but shows again the author's good therapeutic reasoning. Altogether, this little volume will prove of great interest and value to the physician who wants to get a clear and complete picture of this deplorable condition, even though it will make it only plainer to him how powerless he is to arrest or cure this disease. HARTWIGKANDT.

SELECTIONS FROM THE WRITINGS MEDICAL AND NEUROLOGICAL OF SIR WILLIAM BROADBENT, Bart., K.C.V.O. Edited by WALTER BROADBENT, M.D., M.R.C.P. Lond., Henry Frowde, 1908. viii, 444 pp. 8vo. Price: Cloth, $5.50 net. Oxford Medical Publication.

It seems quite appropriate that a choice selection of papers written at various periods during the life of Sir William Broadbent should now be published.

The author graduated in medicine in 1858, and in the following year his first papers on medical subjects appeared. From that time till the year of his death, there were only two years in which he did not publish something, and as a rule something of more than usual interest. All his papers are noted for accurate, independent observation, close reasoning, wide outlook, and clear statement.

This volume contains, among other papers of high

July, 1909

value, one published in 1866, on what has come to be known as "Broadbent's Hypotheses of the Bilateral Association of Nerve Neuclei," also the last paper published by him in 1907, on "The Examination of the Heart." His work represents in time and quality a close correspondence with the progress in medical_science of the second half of the nineteenth century. This volume is therefore of more than usual interest to the students of medical progress during the last fifty years. The wide range of his investigations is shown by the papers on therapeutics, which indicate clearly that Dr. Broadbent did his share of the work of bringing medicine out of that Nihilism in Therapeutics that existed in the first part of the last century. PETER SCOTT.

CANCER OF THE WOMB: Its Symptoms, Diagnosis, Prognosis, and Treatment. By FREDERICK JOHN MCCANN, M.D., F.R.C.S., M.R.C.P. Lond., H. Frowde, 1907. Col. front., x, 172 pp., 46 pl. 8vo. Cloth: $7.00 net. A well-grounded clinical knowledge of the macroscopical pictures presented at an operation coupled with a large experience in symptomatology and the possible sensing of early signs may be sufficient to warrant a trained observer to positively assert the existence of incipient carcinoma uteri without relying on the microscope. It is a much safer procedure, however, in suspected cases of early carcinoma uteri, when a positive diagnosis cannot be made, and where delay means further lymphatic involvement, to have recourse to the microscope.

McCann believes that operation in the early stage can cure. To diagnose in this stage he gives a few rules, signs and symptoms which are not only of interest to the specialist but which would be well for the general practitioner to learn by heart. In the first place, insist on a local examination in all cases of abnormal discharge or irregular bleeding. In advanced cases there is irregular vaginal hemorrhage or a discharge, and probably pain or loss of flesh. Yet it is true that advanced cases of cervical carcinoma with infiltrated vaginal walls may show no loss of flesh, although such cases are exceptional. In early cases there is friability of the cervix, a sign of the greatest importance. The cervix bleeds easily on touch with anything, i. e., the hemorrhage is entirely out of proportion to the injury inflicted. Early cases show the definite occurrence new growth from the service of the portio-cervical canal, or in the substance of the cervix.

Irregular bleeding of any description, or post-coitum bleeding, or a watery blood-tinged discharge are all danger signals. Complete absence of pain is characteristic of the early stage. As most of these cases occur between the fortieth and fiftieth years, and as bleeding owing to menopause is regarded by the patient as one of the symptoms of the menopause, the practitioner should assume cancer present until he can by local examination and other means, satisfy himself that his assumption was incorrect. Remember, as McCann says, that there are high lying cervical cancers, and even carcinoma of the fundus, which detection is possible only after a curettage. In such cases the microscope plays an important role. Excise any suspicious nodules and send them to the pathologist.

Cases suggesting carcinoma of the fundus are those in which atypical bleeding is associated with a sound cervix and portio-especially in old or sterile women, or after the climacteric. The occurrence of cancer in young women must not be overlooked.

As regards etiology, the author believes that the mass of evidence favors the view now held by most pathologists that cancer is a disease of the epithelium characterized by excessive and atypical growth, together in the later stage with a certain amount of inflammatory reaction in the stroma of the affected tissue. The trend of modern opinion is against the parasite theory, as no parasite has been isolated nor inoculations made from a pure culture. It is, moreover, held that the occurrence of cancer in particular localities or houses is merely a coincidence. There is, though, a contact infection, also

305

an inoculation on wounded surfaces. Of the former, epithelioma of the lip and labia are examples. Of the latter, the involvement of vaginal or vulvar wounds during a vaginal hysterectomy, and even later infection or inoculation of the whole pelvis from carelessness during a vaginal hysterectomy for carcinoma cervicis. Inoculation has been held to explain many cases of local recurrence after cancer operations. It is always wise to have a vagina as thoroughly sterilized as possible before operations, and avoid curetting. Allow no cancerous particles to infect the raw vaginal flaps. The cautery for making the anterior and posterior flaps is preferable to the kink or scissors, as the cut edges are seared and sealed by the thermal knife.

Fifty-three years represents the age at which cancer of the body most frequently occurs, while forty-six may be taken as that for cancer of the cervix. The parous woman is more prone than the nulliparous.

McCann believes that well-marked cervical erosion should demand operation, consisting of a complete excision of all the diseased mucosa and the tissue underneath. Such operations, he thinks, are of great importance in the prevention of carcinoma cervicis.

He protests against the instruction to the general public of early sign and symptoms of cancer, and argues that the public should look to better medical education for guidance in such matters.

The book has numerous photographs of specimens taken after removal, which are more truly representative of the actual disease than illustrations, for many illustrations, while of artistic merit, bear little or no resemblance to the diseases as found in the living subject.

His own surgical treatment is described, which follows closely that of other operators. A chapter on the treatment of inoperable uterine cancer will be of interest to those having such cases. Sarcoma uteri and deciduoma malignum also receive attention.

One chapter merits praise, i. e., "The After Treatment of Operative Cases." A few facts noted are: Do not allow a patient ice to quench thirst; give food as soon as vomiting ceases. Food is a good mouth cleanser, it prevents accumulation of flatus and favors its passage, stimulates peristalsis, and urges the bowels to act naturally. Do not allow patients to suffer post-operative pain, for it lower resistance and prevents the beneficent influence of sleep, which tends to restore vitality. A patient, the first two or three days, is constantly worried by enemata, calomel and salts, while rest, the greatest therapeutic agent, is absolutely neglected by some operators

CLARENCE R. HYDE.

GLANDULAR ENLARGEMENT AND OTHER DISEASES OF THE LYMPHATIC SYSTEM. By ARTHUR EDMUNDS, M.B., M. S., B.Sc., Lond., F.R.C.S., Eng. Lond., H. Frowde, 1908. vii, 320 pp., 12vo. Cloth, $3.00 net.

This is an excellent and fairly comprehensive treatise on the diseases of the lymph system.

The volume is profusely illustrated with many halftone plates which are creditably clear and much superior to similar half-tones in far more pretentious volumes.

The author is evidently a careful and competent pathologist as well as surgeon. The book is readable and instructive. A. J. B.

THE CURE OF RUPTURE BY PARAFFIN INJECTIONS. By CHARLES C. MILLER, M.D. Chicago, Oak Printing Co., 1908. 81 pp. 12mo. Price: Cloth, $1.00 net. This little monograph has at least the merit of clearly describing a bad method for the cure of hernia. Evidently the writer anticipated unfavorable criticism, for he says with a certain note of pathos, "Hospital surgeons may be expected to condemn the injection treatment of hernia," and then adds a perfectly gratuitous and unwarrantable insinuation that they do so from interested motives. Dr. Miller is not an hospital surgeon himself and evidently is entirely unaware of