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COMING MEETINGS.

American Medical Association, Boston, June 5-8.

American Climatological Association, Atlantic City, N.J., May 12-14.

American Association of Physicians, Washington, D.C., May 15-16.

Missouri State Medical Association, Jefferson City, May 15-16.

Iowa State Medical Society, Des Moines, May 16-18.

North Dakota State Medical Association, Fargo, May 16-17.

New Hampshire Medical Society, Concord, May 17-18.

American Association of Pathologists and Bacteriologists, Baltimore, May 18-19.

American Gynecological Society, Hot Springs, Va., May 22.

Illinois State Medical Society, Springfield, May 15-17. (Note change of time back to date originally planned).

Connecticut State Medical Society, New Haven, May 23-24.

Indiana State Medical Association, Winona Lake, May 23-25.

Michigan State Medical Society, Jacksou, May 23-25.

Medical Society of State of North Carolina, Charlotte, May 29-31.

Rhode Island Medical Society, Providence, May 31.

American

Dermatological Cleveland, May 30-June 1.

Association,

American Pediatric Society, Atlantic City, May 30-June 1.

American Surgical Association, Cleveland, May 30-June 1.

American Laryngological Association, Niagara Falls, May 31-June 2.

American Association of Genito-Urinary Surgeons, New York, June 1-2.

American Academy of Medicine, Boston, June 2-4.

American Association of Life Insurance Examining Surgeons, Boston, June 4.

American Gastro-Enterological Association, Boston, June 4-5.

American Urological Association, Boston, June 4-5.

American Proctologic Society, Boston, June 5-6.

American Medico-Psychological Society, Boston, June 12-15.

Massachusetts Medical Society, Boston, June 12-13.

Maine Medical Association, Portland, June 13-15.

Minnesota State Medical Association, Minneapolis, June 20.

West Virginia State Medical Association, Webster Springs, June 20-22.

THE REVIEWER'S TABLE

Books, Reprints, and Instruments for this department, should be sent to the Editors, St. Louis.

MANUAL OF OPERATIVE SURGERY. By John Fairbairn Birnie, A M., C. M. (Aberdeen), Professor Kansas State University, Kansas City. Second edition, revised and enlarged; with 567 illustrations, a number of which are printed in colors. Philadelphia: P. BLAKISTON'S SONS & CO., 1012 Walnut street.

This valuable little book on Surgery contains much useful first information. For the student it embraces everything necessary from minor details of sterilization to major work in gastric surgery. For the surgeon it is useful as a reference book, for in it we find many points of information that cannot be found in larger works. Its text is beautifully written, while its illustrations include works of experts. Of special importance is its arti cle on plastic surgery. Here we find in a concise way the various incisions in the cure of facial deformities. The article on hernias is complete and instructing. Much value is drawn from the illustrations and teachings of the Mayos. The reviewer regards this work in a class of its own and would not feel content with his library if it were not included in it. The author deserves much praise for placing this edition before the surgical public, and the publishers should be given much credit for its neat compilation and publication.

J. M. D.

MEDICAL GUIDES ANE MONOGRAPHS SERIES.GOLDEN RULES OF SURGERY. Aphorisms, Observations and Reflections on the Science and Art of Surgery. Being a Guide for Surgeons and those who would become Surgeons. By Augustus Charles Bernays, A.M., M.D., Ddlbg., M.R.C.S., Eng. St. Louis, Mo. St. Louis: The C. V. Mosby Medical Book Co. Price, $2.50.

Aphorisms bright and well founded make up a large part of this book. These appeal

to the reviewer as predigested and merit not only earnest study, but should be instilled or one may better say, injected into the intellect of the student in such a way as to be thoroughly absorbed and understood.

Aside from the real worth of this little book from a scientific standpoint the reviewer has experienced a pleasant evening in its review, for its lines flow along in an unusually classic manner, and can therefore be not only commended for its surgical teachings, but as well for its literary composition.

In the review of this work the writer can find much that is written "between the lines," and can comprehend how space and time have prevented the author from further developing many nuclear sparks of scientific surgery contained in its brief lines. little volume born with the idea on the part of the author to impart to the embryonic surgeon many golden rules and ideas deduced from an experience of thirty years of success

This

ful surgical practice, is an evidence of scientific unselfishness. It is a fact much to be deplored that this work and other similar ones were not written sooner, so as to enable those already engaged in surgical work to adopt its teachings. The author after much consideration and study coins the term "tissue unrest" as a substitute for inflammation. Inflammation as a term to designate the tissue unrest or resisting processes that have its cardinal symptoms heat, pain, redness and swelling, is according to the author obsolete, unreasonable and meaningless. Would that the author should have thus attacked the appendix "itis" as generally employed to denote various inflammations and relegated to the things that were but that are not at present.

The author has with much respect dedicated his work to Dr. Chas Mayo, and has conferred an honor upon him, to whom much honor and praise is rightfully due.

D.

MAN AND HIS POISONS. A Physical Exposition of the Causes, Symptoms and Treatment of Self-Poisoning by Albert Abrams, A.M., M.D., Consulting Physician Denver National Hospital for Consumptives. The Mt. Zion and French Hospitals, San Francisco: President of the Emmanuel Sisterhood Polyclinic: formerly Professor of Pathology and Director of the Medical Clinic, Cooper Medical College, San Francisco. Illustrated. New York: E. B. Treat & Co. (Price $1.50.)

This well known author, has by his original and painstaking clinical research, made for himself a permanent place in medical literature, and this work, adds to his deserving position as a scientist, clinician and teacher.

In this original review of man and his poisons he discusses the relations of poisons to disease, fatigue and general nervous instability. Of especial interest and value is the full discussion of perverted metabolism in its relations to disease, and by careful elaboration he has established a working basis, which is of great value to physicians in general practice, and of special value to neurologists and alienists. We have been personally very much interested in the author's original views regarding neurasthenia and to have the supplementary work to reinforce those views, is of value. We congratulate the author on his deserving success in this field of research. F. P. N.

THE ALIENIST AND NEUROLOGIST for May contains, among many others, the following: Mixoscopic Adolescent Survivals in Art, Literature and Psuedo Ethics-Psychoencephalonasthenia or Cerebrasthenia Simplex and Psychoencephalonasthenia or Cerebrasthenia Insaniens Erotic Symbolism - Railway Railway Brain Strain and Brain Strain Regulation of Railways-Legal Aspects of Epilepsy The Errors of Lombroso on Moral Insanity and Crime-Just a Sample-Congres Inter

nationale Pour L'Assistance Des AlienesA Milan Railway Inhumanity-The Hazing Neuropath and College CircumspectionAutomobile Delusion-Le Progres Medical, Number Four, November 14, 1905-Psychopathy in the Sanctuary-The Surplus Funds in the Treasury of the A. M. A.-The McNaughton Case-Marriages by the Insane -Lay Evidence as to Insanity-Philanthropy and Applied Science-An Unjust Judgment Against a Physician-The Crimes of Fatal Euthanasia-Personal Commendation of a worthy Medical Insane Superintendent-Schoolboy Truant, but cannot Help it. Also a large number of Selections, Reviews, Book Notices, etc. Sample copy free on request. Subscription, $5 per annum in advance. Address L. H. Hughes, manager, 3872 Washington Boulevard, St. Louis, Mo.

IN cough due to pregnancy Dr. Jewitt gives sedatives, such as a pill of palerinate of iron, quinine and zinc after meals; or cannabis indica or bromides.

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"REFLEX LIGHT FROM AFRICA, a discussion of the nergo problem in America in the light of conditions in Africa, to appear in the May Century from the pen of Mr. Charles Francis Adams, promises stirring reading. It is known that Mr. Adams, after careful study of the black in Africa, believes that the nergo is essentially and hopelessly inferior to the white man; that white and black cannot flourish together under the same sytsem of government; and that the only solution for the United States of the problem of its relations with San Domingo, Cuba and the Philippines is to establish an up-to-date, dependent-people policy.

Mr. Adams will set forth fully his position and the findings in Africa upon which he bases it-a position sure to excite much lively discussion.

THEORY AND PRACTICE.-Sydenham, some 250 years ago, reommended that young men desirous of studying medicine should lay aside their books and read Don Quiote! He had a profound contempt for the book learning of his times. While he knew the current theories, instead of trying to make them the basis of his practice he relied mainly upon observation of the natural processes of the body and their various normal and abnormal manifestations. His aim was to aid Nature and to avoid harming her. Instead, therefore, of the complex remedies and prescripticns of his times he gave simple remedies and carefully watched their actions. studied his patients and left theorizing to others. And he was wonderfully successful. -American Journal of Clinical Medicine.

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REPORTS ON PROGRESS

Comprising the Regular Contributions of the Fortnightly Department Staff.

SURGERY.

JOHN MCHALE DEAN, M. D.

The Surgical Treatment of Cancer of the Stomach.-Wm. J. Mayo (Jour. A. M. A.) graphically describes the treatment of cancer of stomach. The author begins his article with truthful and bold statement that no authentic case of cancer of the stomach was ever cured by medicine. Would that this statement will open the eyes of the practitioners to this conclusive fact, and convince them that cancer of the stomach is no medical disease, but a strictly surgical one. The results of the author's cases show a low mortality of 5%. When we understand that cancer of stomach means inevitable death, why not give the unfortunate patient a chance for life by opreation? The article is illustrated by artistic, clear drawings that are so instructing that the valuable text is well understood. The patient operated on is given one-sixth of a grain of morphia hypodermically one-half hour before the ether anesthesia is begun. An incision is made in the median line between the umbilicus and ensiform cartilage small at first for exploratory purposes. If the case on account of extensive involvement is found inoperable the incision is closed, if not the incision is enlarged and the operation of resection begun. The stomach is drawn downwards and lesser curvature immobilized, while the liver by an assistant is elevated. The coronary artery at suitable point is doubly ligated, as well as the gastroepiploic dextra, gastroduodenal arteries. The gastrohepatic and gastrocolic omentum is ligated and incised. Clamps are applied to the duodenum and stomach, and the portion is removed. The gastric stump is closed with through and through catgut using the C. H. Mayo stitch while the outer coat is sutured with linen. The duodenal stump is either closed and on independent gastrojejunostomy performed, or if long enough is anastomosed with the stomach according to Kocher method. Saline solution, according to the Murphy method, is used per rectum, and one to one-half ounce of hot water allowed by stomach every hour after the sixteenth.

A Plea for the International Study of Carcinoma. Nicholas Senn (Jour. A. M. A.) in a paper read before the International Medical Congress at Lisbon makes a plea for the international study of carcinoma. He avers that while much has been done in a curative

way much should be done in a preventive way. The etiology of carcinoma. is still as unknown today, as it has ever been. The possible parasitic origin of carcinoma is not tenable according to Senn. He has inocu

lated himself with carcinoma with the same negative results that many have had previously. Autoinoculation has shown negative results as well. It is essentially a local disease of embryonic or postnatal epithelial causation. Heredity influence has been found in statistics to the extent of 12 to 33% till predisposition or aptitude for carcinoma may be transmitted from generation to generation as well as congenital deformities and physionomies have. It is most prevalent in the aged, although the author has seen carcinoma of the breast in a girl of 21 years and rectal carcinoma in a girl of 17 years. The reviewer has seen a case of carcinoma of the stomach in a girl of 23 years. Carcinomas grow more rapidly in the young than in the old. When it occurs in the youth the case more malignant than when it occurs in the aged. Racial and social influences seem to play some important role in its occurrence. The yellow and black races as well as the North American Indians seem little or not all affected with carcinoma. Habits, customs and manner of living predispose the more civilized nations to it. Strenuous life, worry and discontent often proedispose some to it. Climate and topography have their peculiarities about its prevalence. Rare in the extreme North and South; rare in Central Africa, South Sea islands, and Central America, and almost unknown in New Guinea; most frequent in temperate zones of Asia Europe and America. Alluvial soil favors it, chalky or lime soils exercise an opposite influence. The reviewer offers a query at this juncture that probably these localities where it is not prevalent it is not seen or recognized. If it is uncommon among the ignorant races could it not be possible that it has been less recognized and studied thera? Meat diet some claim as favoring its development, but the author states it is very rare in the Arctics where the native live exclusively on a meat diet. The author offers a possible explanation for its rarity here on account of iodin contained in the food obtained from the sea animals. Habits of life is thought to predispose to it as we often blame the claypipe for sublabial carcinoma, yet in Turkey, Palestine, Algeria and Morocco, where tobacco is extensively used by the natives carcinoma of the lip or mouth is of rare occur

rence.

That constant irritation produced by tobacco to the mucous membrane of mouth and tongue may predispose to is plausible.

Trauma evidently plays an important part, and so important that it is often overlooked. Still trauma favors more the development of sarcoma than carcinoma. Often as the author states the trauma merely calls the phy. sician's attention to its presence. Prolonged irritation from occupations, habits, malpositions, diseases of teeth and displaced organs form some factors in factors in its development. Chronic inflammations or ulcerations have been repeatedly shown to antidate its occurrence. This has been so often demonstrated in regard to ulcer of the stomach developing malignancy or of an ovarian tumor becoming carcinomatous. Warts, "verruca senilis' have been shown to be the starting point of epitheliomas. Scar tissue and benign tumors also favor its development. The author concludes with a strong plea for the study of the cause of cancer. He urges the various international scientists to work unitedly in this direction, and to wander from the laboratory to study the etiology as well as the phases of the disease from the facts he has enunciated in his paper.

DERMATOLOGY.

ROBERT H. DAVIS, M. D.

A Note on the Treatment of Simple Warts by Internal Remedies.-Hall (British Journal of Dermatology, March, 1906) reports an interesting case of multiple warts cured by active daily purgation extending over two months and a half. This treatment has been brought forward before, some ascribing its virtues to epsom salts alone, but, in this case, sulphate of magnesium failed to properly move the bowels, and had no effect on the warts. Aloin and nux vom., in pill form, gave the necessary relief, and the warts disappeared in two months and a half. They had been present for some years, and were very numerous, 367 being on one hand and wrist only. (J. B. Cooper, in British Med. Jour., August 26, 1905, reports cures of multiple warts by lime water taken internally. He made the observation accidentally, on himself, while taking lime water for some digestive disturbance for a period of ten days. At the end of two weeks, a wart on his thumb, that had not yielded to local treatment, had entirely disappeared. He tested other cases with marked success. The time taken for the total disappearance of the wart varies from four days to six weeks. He advised the use of the remedy in wineglassful doses with a little milk added to be taken after the mid-day meal. Per Review in Jour. Cutan. Diseases, Feb., 1906.)

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Additional Observations on the Use of the Roentgen Rays in Dermatology.-Stel wagon (Jour. Cut. Dis., March, 1906) gives an interesting and instructive résumé of his broad experience with the X-ray, during the last three years, in the article referred to. His conclusions are, 1st, that a coil is more convenient and less liable to get out of order than a static machine, but is more dangerous in the hands of the inexperienced, "or the experienced either.' 2d. That the vacuum of the tube should rarely exceed at the most, that equivalent to a three-inch spark, and between one and two is best. 3d. He advises changing the vacuum during a treatment, that is, he begins an exposure at a vacuum equal to about a one or two inch spark, and then disconnects the regulator, and allows the vacuum to slowly rise during the exposure. lieves that the disease, in its varying depth, can be better influenced in this manner. This applies more especially in the treatment of epithelioma, and in other growths of some depth or thickness. 4th. In the majority of cases, no improvement occurs until X-ray dermatitis (erythema, etc). has been excited. Excepting epithelioma and similar diseases, however, it should not be purposely allowed to go beyond the slightest possible erythema. (By following this procedure, he occasionally causes a second degree burn, but finds the discomfort and disfigurement only temporary as a rule). Exceptionally, atrophic changes, such as thinning and wrinkling of the skin, atrophic lines, and spots follow careful, and even moderate use of the ray. This he has observed in a few cases of acne treated, and in only one was it at all marked, and, in that case, the changes are slowly becoming less marked. These changes did not develop until several months after the last cycle of exposures. 5th. As to time of exposure, and distance of the tube, he recommends, in the first several seances, except in the case of epithelioma and other malignant dermatoses, a distance of ten inches from the tube, and an exposure of three minutes. epithelioma the duration of first exposures can be five minutes. In the milder dermatoses, six to eight inches in point of distance, and ten minutes exposure should rarely be exceeded, and these limits cautiously reached. In malignant dermatoses the limits can be more extreme, and much more boldly approached, "the tube in obstinate cases almost touching the surface, and the duration extended to fifteen or twenty minutes longer." (It is almost needless to say that such treatments as these last should be given only by a skilled operator, that the patient should be under constant observation, and that the cases are desperate that require such

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heroic measures.-Ed.) In changing from one tube to another, in the same case, dura. tion should be lessened, and distance lengthened for the first two or three exposures, as different tubes may have different degrees of action. 6th. The usual measures for protecting the patient, and operator should be taken. 7th. As regards special diseases (a) epithelioma. "The best of all treatment is, first enucleation, either by excisión, curette, or cauterization, as may seem most expedient in the individual case, and the immediate, supplementary action of the X-rays to the extent of probably five, or ten, or more, moderate exposures. He thinks this plan would give the most rapid results, give the least chance of recurrence, and be the least expensive, in the long run, to the patent. (Of these conclusions there appears to be little doubt but most patients dread an operation, and prefer the slower and less certain way. Ed.) (b) lupus vulgaris. The action here is sometimes brilliant, but always slow, and cannot be predicted in a given case. (c) (c) Lupus erythematosus. Here it is only occasionally satisfactory. (d) Acne. Although relapses after its use are less common than with other methods, his conclusions are that its use in acne should be extremely cautious, and that it is probably best reserved for the obstinate and extensive cases. The best and quickest results are attainable only after the production of a mild erythema, and the danger of subsequent atrophic changes, as already mentioned, should be borne in mind. Such changes may not occur for several months after exposures bave been discontined. It is not improbable, also, that a downy growth of hair is stimulated at times by the ray. So, in the obstinate cases, when the ray is employed, it should be used cautiously, and in conjunction with the other known methods of treatment. (e) Psoriasis. Bere it should be used only for obstinate cases and large areas. (f) Eczema, only in obstinate, thickened areas, and rebellious, localized forms, as, for example, persistent eczema, of the hands, but here it should be employed with great caution. (g) In sycosis, he has had good results, but uses the ray cautiously, and in conjunction with the ordinary methods of treatment. (h) In keratosis of the palms, and localized hyperidrosis he has obtained good results as have many others. (i) In ring worm of the scalp, the results were very favorable, but the pastiles of Sabouraud and Noiré, for measuring the dosage were unreliable. He concludes with the advice that in non-malignant dermatoses, except in extremely obstinate cases the ray should be used more as an adjunct than as the sole remedy. In the discussion

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following, there was considerable disagreement over the statement that in acne erythema must be produced in order to accomplish a good result. The majority were against the production of an erythema. Duhring had experienced alarming results in one case of psoriasis, when, without warning, a violent reaction, with suppuration extending down to the subcutaneous connective tisMontgomery and Bronson had had excellent sue, occurred in the patch under treatment. results in rosacea when the ray was used as an adjunct to the usual constitutional and local measures.

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Two Cases of Multiple Tumors of the Skin in Negroes, Associated with Itching.-Schamberg and Hirschler (Jour. Cut. Dis., April, 1906) report two unique and interesting cases of a trouble reported in 1880 by Hardaway, with no cases reported since until now. lesions consist of nodules, varying in size from a pea to a small finger nail. They are situated mostly on the extensor surfaces of the arms, on the dorsal surfaces of the hands and fingers, on the back and the extensor surfaces of the legs. The soles of the feet were free in each case, and the palms in one, the other exhibiting a single nodule on the thenar eminence. The nodules were sharply circumscribed, and showed tendency to a coalescence. The skin between the lesions was normal in their cases, in Hardaway's, there were thickened, pigmented plaques in the intervening skin. Hardaway's case showed also lesions on the palms and soles. The nodules are not painful or tender, and are firm to the touch, most of them distinctly elevated, and covered with a somewhat horny epidermis. In each case, the nodules developed in the course of a few weeks, and have never disappeared, remaining, in one instance, more than fourteen years. No new ones appeared after the first crop, but some of the early ones grew slowly. The outbreak is attended by violent itching which is with difficulty controlled, and has been continuous since the onset, being much worse at sometimes, e.g., the menstrual period, than at others. period, than at others. In Hardaway's case, some of the nodules were confluent, and the trouble began in the form of "blisters, which were followed by the development of the tumors. In all the cases, the nodules recurred after extirpation. Pathologically there was a dilatation of the cutaneous blood vessels; cell infiltration chiefly in sharply circumscribed masses; proliferation of the fixed, connective tissue elements; and the formation of new, collagenous fibres. the larger tumors, there was more pronounced vascular dilatation, and an enormous over

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