ment is turning to medical men for authoritative
facts and conclusions to enable them to realize
the causes, means of prevention and c. re of th s
evil. This new society comes to meet this want
by enlisting medical men as members and stimu-
lating new studies and researches from a broader
and more scientific point of view. As a medical
and hygienic topic the alcoholic problem has aa
intense personal interest, not only to every physi-
cian, but to the public generally in every tow 1
and city in the country. This interest demanfds
concentrated efforts through the medium of a
sopiety to clear away the present confusion, edu-
cate public sentiment, and make medica] m.n the
final authority in the consideration of the reme-
dial measures for cure and prevention. For this
purpose a most urgent appeal is. mad 2 to all
physicians to assist in making this society the
medium and authority for the scientific study of
the subject. The secretary, Dr. T. D. Crothers,
of Hertford, Conn., will be pleased' to give any
further information.
Secretary :
We have the honor to report to you that at a
meeting of the Department of Pub'ic Instruc-
tion, held August 26, 1904. the resolution submit-
ted by tJie committee appointed by the State
Medical Society at its last meeting to encourage
the examination of the " eyes and ears of tie
school children throughout the state was adopted
The same resolution will be pre^e ted to the
State Board of Health and an early action i^
anticipated. Resnectfully yours,
Walter R. Parker^ M. D ,
Chairman.
Charles G. Baker. M. D.,
John R. Rogers, M. D.,
Committee.
^Detroin Aug. 29, l^^^i^ed byGOOglC
466
BOOK NOTICES.
Sooft Dotice0.
Jour. M. S^M. S.
Un,der the charge of
RAY CONNOR.
The PfcACTicAL Application op the RStfTCEN Rays ik
Therapeutics and Diagnosis. By William Allen
Puaey, A. M., M. D., and Eugene W. Caldwell, B. S.
Second edition, thoroughly revised and enlarged.
Handsome octavo volume of 690 pages, with 196 illus-
trations, including four colored plates. Philadelphia,
New York, London: W. B. Saunders & Co., 1904.
Cloth, %5.Wi net; Sheep or Half Morocco, $6.00 net.
Now that the ^iamor surrounding the extra-
vagant claims made Isf enthusiasts in the use of
the Roatgen Rays has suboidgid, it is foitimate
that Pusey and Caldwell have been tMfc to put
a new edition of their work upon the market.
Naturally during the year there has been much
improvement in technique and it is to be regjret-
ted that Caldwell has not seen fit to bring his
excellent treatise of Part I on X-Ray Apparatus
and Its Use in EHagnosis up-to-date. It is espe-
cially by these new and more precise methods
of technique that we are enabled to* interpret the
details of the. radiographic image with greater
precision; and as .this . dnteiprctation becomes
more exact it becomes more valuable as an aid
to diagnosis. There has not been, as far as we
have observed, one material word changed or
added to Part I.
Pusey, however, in Part II on the Therapeutic
Application of X-Rays has very jnaterially en-
larged the work. Much has been written during
the year and he has carefully reviewed this lit-
erature, giving the resume, and what is more in-
teresting and practical, has brought down to this
year the history of his own cases with a frank-
ness which renders his conclusions most trust-
worthy. He states that the study of this vast
amount of literature and his own extensive ex-
perience has not led him "to change in any im-
portant particular either the therapeutic indica-
tions for the application of X-Rays, or the gen-
eral conclusions as to their field of usefulness."
In the first chapter, on the effects of X-Rays
on the tissues, he devotes a few extra para-
graphs on the after-effects on the skin; on the
extensiveness of burns involving the subcutaneous
tissue, and to the long duration of X-Ray effects.
In the indications for the therapeutic uses of
the X-Rays a few more of the rarer diseases have
been added to the list of possible amelioration, as
gathered from reported cases.
Pusey still believes that in the treatment of
acne this form of medication is the most useful ;
but he advises very weak exposures, which re-
duce to a minimum the dangers of a burn.
Reporters have noted especially favorable re-
sults in hyperidrosis and seborrhcea, in eczema,
psoriasis, lupus, erythematosus and lupus vulgaris,
etc.; and much improvement in the treatment of
the tuberculous cervical gktnd, ttd>ercuk>09 smuaes
and tuberculous kskms of other portiaps of the
bmfy.
It ts particularly ¥ritb 4he cases of cutaneous
nrriwiim 4tnt so much has been expected ; and
so the chapter on this subject, with the detailed
report of cases, is most interesting. A more ex-
tensive experience has not only not altered
Pusey 's views, but has made his opinion more
emphatic.
It is these details regarding the use and man-
ageioent of the various apparatuses; the many
illustrations of clinical cases; the authors' exten-
sive and well recognized views of the practical
application of the Roentgen Rays in disease, which
stamp the work as authoritative, practical and
finished.— A. P. B. ^
A Text>book of Pathology. By Joseph McFariand, M.
D. Octavo Yolume 818 pages, with 860 illustrations, a
number in colors. Cloth, $5.00 net; Sheep and Half
Morocco, $6.00 net. Philadelphia, New York and
London. W. B. Saunders & Co., 1004.
The difficulty in writing a thoroughly satisfac-
tory Pathology can hardly be over-estimated.
The subject is one so large that a life time of
study is too brief to cover it all and to condense
this into a book of a few hundred pages is quite
impossible. The question becomes rather one of
what shall be omitted than what shall be put in,
and this largely depends on the audience for
which the book is intended. The work before
us is primarily for the student of medicine and
the points likely to be of value to him are those
chiefly dwelt upon, while those of purely theo-
retical interest are less fully discussed.
Under General Pathology, the first part of the
book, are discussed such topics as the etiology of
disease, pathology of nutrition, parasitism, im-
munity and infection and infectious diseases.
The consideration of diseases of the cardio-vas-
cular, respiratory, reproductive systems, etc.,
comes under the second part of the work, Special
Pathology. In order to make the volume as
compact as possible, the less impartant material
Digitized by VjiOOQIC
October, 1904.
BOOK Noticaa.
467
is put in fine print. The illustrations are very
numerous and drawn from many well known
standard works. They are much above the aver-
age in excellence and are especially strong on the
clinic side of pathology.
The pathology of the nervous system is not
given quite so much room as in many text-books
and much that is given is put in the smaller
type. The index at the close of the book is very
full and complete and adds greatly to the value
of the work.
A Systkm of Practical Surgery. By Prof. E. von
Bcrgmann, of Berlin; Prof. P. von Bruns, of Tubin-
gen, 8Qd Prof. J. von Mikulicz, of Breslau. Edited
by Dr. William T. BulL To be complete in five im-
perial octavo volumes, containing 4,000 pages, 1,600
engravings and 110 full page plates in colors and
monachrome. Sold by subscription only. Per volume,
cloth, $6.00; Leather; $7.00; Half Morocco, $8.50.
Volume IV just ready.' 757 pages, 346 engravings,
16 pages, i<ea Brothers & Co., Philadelphia and New
York, 1904.
The fourth volume of this system is giveti up
to that most important and modern of all the
branches of surgery, namely that of the alimen-
tary tract. The list of contributors to this vol-
ume is made up almost exclusively of professois
and their efforts supplemented by those of the
American editors have succeeded in bringing out
a very valuable and comprehensive work.
In the section on the oesophagus, Prof. v.
Hacker giv^s an excellent description of oeso-
phagoscopy, its technic and uses. A plate of
colored sketches serves to illustrate the pictures
that are obtained in the studies of oesophageal
cancers. It is comforting, however, for the gen-
eral practitioner to bear in mind that even when
found these growths have as yet proved entirely
inoperable. The section on the surgery of the
stomach and intestines is by Prof. v. Mikulicz
himself. Appendicitis is treated at some length
and the various forms of intestinal anastomosis
•described.
Prominent amongst these is the Murphy but-
ton which is fully described and illustrated. It
is even used by the Germans themselves when
time is a great object and is the only mechanical
aid which has as yet received very widespread
adoption.
A section is devoted to hernia and another to
the liver and biliary passages. Two brief sections
on the spleen and pancreas complete the volume,
"which is one of the best yet published in the
series.
The illustrations, while not quite so n -
merous as in some of the preceding volumes, are
"very excellent and add much to the value of the
l)ook. The text is rendered in the same clear
idiomatic English as in the preceding volumes
£tnd the proof reading seems on the whole to be
IV ell done despite a few slips which have escaped
Sittention. An index closes this volume as in the
:foregoing ones and adds to the usefulness of the
-work for reference.
The Cumicai. TaxATxaEs ih the Pathology ksd
Thbra»x or DisoRDBn OP Mbtabousm and Nutri-
tion. By Prof, Dr. Carl von Noorden. Translated
under the Erection of Boardman Reed, M. D. Part
II. Nephritis. Small 8 vo., 112 pages. Cloth, $1.00.
E. B. Treat ft C<K, N«w York, 1904.
The rational treatment of chronic diseases pre-
sent often many perplexing and troublesome
points. It is therefore with gratitude that one
turns to any source of lig^t available. Perhaps
no one is better qualified to speak with authority
on the treatment of nephritis than Prof, von
Noorden, as so much of his time has been given
up to the study of the problems involved. He
has departed from the traditional methods of
treating nephritis in certain important respects
and always with a reason for the faith that is in
him.
The customary methods of treatmerit are first
considered and then the facts and principles
which underlie the therapy of first the acute and
then the chronic forms. As is pointed out, tco
much stress can easily be laid on the amount of
albumen excreted in the urine. The general con-
dition of the patient must be taken into consid-
eration, as it often happens that while the albu-
men is increasing slightly, the general health of
the patient is also improving steadily, and there
exists no call for a gloomy prognosis.
This little book is very practical and exceed-
ingly stimulating in its thought. The translator
has succeeded in putting it into clear idiomatic
and readable English. The proof reading is not
as well done as one could wish, but the work as
a whole very well repays the time and trouble
of a perusal.
Clinical Tkbatisss on the Pathology and Therapy of
Disorders op Mbtalsousii and Nutrition. By Prof.
Dr. Can von Noorden. Translated under the direc-
tion of Boardimn Reed, M, D. PRrt III. Colitis.
Small 8 vo., 64 pages. Cloth, 60 cents. E. B. Treat &
Co., New York, 1904.
In this little essay the author takes up mem-
branous catarrh of the intestines or colica mucosa
and considers first the pathology, and then the
treatment. This, by no means rare disease, while
almost always associated with both constipation
and neurasthenia, has still another element in its
causation which von Noorden well calls a secre-
tory neurosis. The various views of other prom-
inent clinicians are gone into rather fully, as on
the view taken of the pathology rests very large-
ly the subsequent therapy.
The method of treatment employed in this
class of cases has as its main object the promot-
ing of the normal functioning of the intestit:al
tract and the means to this end are laid down
clearly, definitely and in a thoroughly practical
form. The striking feature of the treatment here
as in nephritis is that drugs are conspicuous by
their absence. The results that have been ob-
tained by the application of the principles given
are very striking indeed for such a troublesome
disorder. Only about 5 per cent, of complete fail-
ures have to be reported.
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468
PROGRESS OF MEDICAL SCIENCE.
proflrcfis of flDcMcal Science*
Jour. M. S. M. S.
MEDICINE.
Under the charge of
HARRISON D. JENKS.
Bacterium. — This is defined by Krogius as
"characterized, on the one hand, by the pres-
ence of a great number of microbes in the
urine freshly passed, and on the other hand
by the absence of pronounced symptoms indi-
cating an inflammatory process of the urinary
organs." This second part means absence of
pus in the urine. While this condition was
first described in 1881 by Roberts, who noted
an acid urine with strong disagreeable odor
comparable to dead fish, little was done fur-
ther on it until 1891. Sixty-seven cases have
been carefully observed, of which 56 gave the
colon bacillus as the cause, seven had staphy-
lococci, and it is also known that in typhoid
there are 20 to 30 per cent, affected with bac-
teriuria; the colon and typhoid infections are
both of renal origin.
The mere presence of virulent bacteria in
the urinary organs, whether made experi-
mentally or transmitted by the kidney in the
course of a typhoid fever or mingled with the .
pus of cystitis is not enough to cause bait:r.-
uria. It is necessary to have a pari.tal kso.i
to cause the trouble. This parietal lesion may
he in the prostate or seminal vesicles, or in th.i
pelvis of the kidney. Of the latter, typhoid
bacteriuria, when there is an acute catarrhal
pyelitis, is important, for proper treatment
will prevent a beginning of a chronic inter-
stitial trouble. Puerperal bacteriuria is im-
portant, but has been entirely neglected. It
is probably common, due to the colon bacillus.
Here again proper recognition is essential for
the prevention of chronic affection of the kidney.
Again, in chonic catarrhal pyelo-nephritis b c-
teriuria is a common trouble.
The treatment is simple and in the typhoid
and puerperal cases rapid and complete; uro-
topan, 2, 4, 6, 8, tablets a day and diluent
water.
It will be seen that bacteriuria is a sym-
tom, not a disease. Yet it is the only
striking feature of certain diseases, especially
catarrhal pyelitis, either typhoid, puerperal, or
acid retention. Cystitis never causes bac-
. teriuria. — (The AVzc York Medical Journal,
August 27, 1904. E. L. Keyes, Jr.)
The Adams-Stokes Symptom Complex. — In
1803 Huchard proposed the name Adams-
Stokes disease for a remarkable symptom — -
complex characterized by temporary or per-
manent bradycardia, loss of consciousness, to-
gether with apoplectic or epilectiform seiz-
ures. According to him, the condition is usu-
ally if not exclusively encountered in individ-
uals of advanced years and is indicative of arter-
iosclerosis of the cardiobulbar type.
The following general conclusions are
drawn from the experimental data- obtained:'
1. The blood pressure is constantly very high,
ranging from 170 to 250 mm.
2. The great arterial trunks of the extrem-
ities are fairly elastic.
3. Although very high blood pressure has
existed for at least a year, the urine is normal
in volume and specific gravity; there is little
evidence of diffuse interstitial nephritis or of
left ventricular hypertrophy.
From this it follows that the high pressure
is well borne by the heart and kidneys.
4. Acute exercise, as a rule, has no accel-
erating action on the pulse. I have never
counted an increase greater than two waves
per minute. On the other hand, it occasion-
ally exaggerates the bradycardia.
5. Exercise invariably causes a sharp rise
of pressure.
It seems difficult to harmonize such contra-
dictory findings with the prevailing theory of
the ^circulation. There is a manifest 4isparity
between the laggard work of the heart and
the tremendous pressure at the periphery.
This appears to be too great to permit of ex-
planation by a theory which assigns to the
left ventricle almost the entire work of over-
coming the inertia of the blood column. To-
day there is reason to believe that the arterial
system and the capillary network of the peri-
phery constitute a powerful secondary mech-
anism in constant rhythmic activity. Such an
assumption assumes that other portions of
the blood vascular system besides the heart
wall, contribute a large quota of the driving
energy. Hasebroek in "1903 attempted to es*^ah-
lish a new theory of the circulation, which
gives this secondary apparatus (arterial sys-
tem and the vast capillary network of the
periphery) a more definite value. It is my
belief that the so-called Adams-Stokes phe-
nomena are highly suggestive of the existence
of such an auxiliary mechanism dominated by
the- vasomotor system. — (The American Journal
of tli-e Medical Sciences, September, 1904. Clar-
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October, 1904.
PROGRESS OF MEDICAL SCIENCE.
469
SURGERY
Under the charge of
MAX BALLIN.
Surgery of the Diaphragm.— A man 30
years old was stabbed in the left side, collapse
and hemoptosis followed. Three hours aft^r t'.:e
accident, the kft pleural cavity was opened freely,
by enlarging the stab-wound along the sixth rib.
The lung was found collapsed. The fundus of
the stomach was prolapsed, through a rent in
the diaphragm, into the pleural cavity. The stab-
wound had penetrated the prolapsed part of the
stomach for a length of two inches, and stomac'i
contents had escaped into the pleural cavity. Thj
wound in the stomach was closed by a do:b'e
row of Lenibert sutures, the pleural cavity was
cleansed, the stomach was replaced, through the
rent in the diaphragm, which proved to be one
and one-half inches long, and the diaphragm
was sutured by interrupted silk stitches. The
peritoneal cavity was then opened, in order to
ascertain the condition of the posterior wall of
the stomach, but no other lesions were found.
The opened pleural cavity was drained. Bro i-
chitis and empyema of the injured side made t'le
recovery slow, but the patient finally got well.
From this case and a review of the literature
on this subject, Neugebauer concludes that all
diaphragmatic hernias should be sutured from
the thoracal side, (Archiv. fuer Klinische Chir-
urgie, 1904, vol. 73, Part iv, F. Neugebauer.)
The Significance of Acute Jaundice Fol-
lowing Surgical Operation. — £. H. King, of
Muscatine, Iowa, reports three fatal cases of acule
post -operative jaundice. The first occurred in a
young man suffering from an appendicular ab-
scess. Acute jaundice set in on the third day,
coma and death on the sixth.
The second case was in a child, 4 years old,
suffering from the same malady. Jaundice devel-
oped on the third day, coma, convulsions :in.l
death on the sixth day.
The third case occurred in a woman, 25 yeirs
old, operated on per vaginam, for a hematocele.
Acute jaundice developed on the third day, cr>mi
and death the sixth day.
Personal inquiry of a few of our leading sur-
geons, and former publications, leads one to be-
lieve that this postoperative complication is of
"occasional occurrence."
King does not think that chloroform by itself
should be made responsible for acute jaundice
following operation. His conclusions are:
(1) That post-operative jaundice oc:ason lly
occurs and is a symptom of grave import.
(2.) That it presents the clinical picture of
acute yellow atrophy of the liver.
(3) That from the predominence of abdomir.al
cases, traumatism to the peritoneum and inter-
ference with the portal circulation are the probable
cause, and the anesthetic, possibly, is the inciting
factor in producing this complication. {Ameri-
can Journal of Surgery and Gynecology, July,
1904, E. H. King.)
Suture of the Brachial Artery. — A young
man, 17 years old, had his left arm badly crushed
between elbow and shoulder. Drainage of the
lacerated wcmnd was established. Seven days
after the injury profuse hemorrhage occurred.
The wound was opened and a funnel-shaped ulcer
of the brachial artery was found. At every pulse
beat, the blood stream was forced out through
this hole; there was no radial pulse, the arm was
cold and cyanotic. The hole in the artery was
closed by one purse-string su'ure, which con-
trolled the hemorrhage. A pirtion of the ad-
joining muscle was grafted over the sutured por-
tion of the artery. The arm was kept on a right
angle splint. The radial pulse returned in 5
hours. The patient is getting a complete use ol
the arm. — (Annals of Surgery, July, 1904, G.
Torrance.)
To Increase the Resisting Powers of the
Peritoneum. — As it is out of the question to
specifically immunize because of the muhiplic ty
of the causal agents, Mikulicz accomplishes his
aim by inducing an artificial leucocytosis. It wa'>
found that nucleic acid was the most efficient
agent for this purpose. It frequently produced a
hyperleucocytosis of 25,000. The maximum is
reached in man about 12 hours after the injec
tion. It was tried in man in 34 instances. A 1
the patients passed through the d.ingerous firs:
week without any peritoneal complications. The
operations included 7 resections of the st^mac'i,
13 gastroenterostomies and other severe abdom-
inal operations. He injects 50 c. c. of a 3 per
cent, solution of neutralized yeast, nucleic acid
injected subcutaneously in the chest wall. H?
urges the copious rinsing of the abdominal cavitv
with warm physiologic salt solution, as this tend-
to increase the number of leucoc>tes in the peri-
toneum besides its other advantages. (CVn'rj-
blatt. f. Chirurgie, Leipsic.)
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470
PROGRESS OF MEDICAL SCIENCE.
Jour. M. S. M. S.
GYNECOLOGY AND OBSTETRICS.
Under the charge of
B. R. SCHENCK.
The Blood in Pregnancy. — From the time
of Morgagiii the constitution of the blood dur-
ing pregnancy has been a subject of interest
to many investigators and has given rise to a
great deal of discussion, which unfortunately
has not led to uniform conclusions, even in
the hands of those working with mode n
methods.
Three views have prevailed as to the^ num-
ber of erythrocytes and amount of hemoglo-
bin. (1) A diminution in the number lof red
blood cells and of the hemoglobin; (2) a de-
crease in the number of red blood cells and
an increase in the amount of hemoglobin; (3)
no change.
A leucocytosis has been uniformly observed,
the maximum figure given being 16,500 per
cu. m. m. Virchow referred the leucocytosis to
the widening of the uterine and abdominal
vessels and to the increase in metabolism in
the uterus and its contents.
Most observers have noted a fall in the
specific gravity.
Endeavoring to clear up some of the doubt-
ful points, Thompson made monthly exam-
inations of the blood of 12 pregnant women.
This included the enumeration of the red
blood cells, the estimation of the hemoglobin,
the enumeration of the leucocytes, the differ-
ential count of the leucocytes and the deter-
mination of the specific gravity. Xhe latter
was estimated by the Hammerschlag metliod,
using a mixture of benzol and chloroform.
From the study, Thompson reaches the fol-
lowing conclusions:
1. A moderate decrease is observed in red
blood corpuscles rather early in pregnancy,
remaining subnormal throughout the middle
months, to rise again to normal at the ter-
mination of pregnancy — not, however, in all
cases.
2. A low percentage of hemoglobin, con-
stant throughout the first seven months, rap-
idly approaching normal as pregnancy draws
to a close.
3. A slight absolute leucocytosis exists in
every case of pregnancy, but this slight leu-
cocytosis does not support the theory that it
is due to any positive chemio taxis.
4. There is no variation from normal in the
different forms of colorless corpuscles, the
leucocytosis affecting all forms of white cells
alike.
5. The specific gravity is high at the onset of
pregnancy, diminishing by progressive steps, to
reach its lowest level in the middle months,
rising to normal at term. {Johns Hopkins Bul-
letin, June, 1904.)
The Prevention of Puerperal Sepsis in Pri-
vate Practice. — Byers states that spontaneous
delivery is very rarely followed by signs of
puerperal infection, provided the patient has
never been examined internally. Leopold has