after results of these operations than from any other class of gynecologic surgery. If anatomical considerations are not taken into account, the patient's condition has not improved and she has become thoroughly conscious of it. With a fair knowledge of surgery and a careful and conscientious study of the text and illustrations, it would appear that the operator should, if he has made a good diagnosis, be able to secure satisfactory results.

The same may be said of chapter four in relation to Pelvic Floor; Relaxation.

Commencing with chapter five, we have to deal with inflammatory and nutritive diseases of the uterus which involves somewhat less accurate operative technique, but an accurate diagnosis.

With chapter six to eight inclusive, we have to consider accurate diagnosis, and accurate technique, because the conditions relate to life saving and comfort to the patient. These conditions include myomectomes and hysterectomes, including operations for carcinoma of the uterus.

Among other methods of treatment the use of heat is discussed, especially the Percy cautery..

An important chapter relates to acute pelvic inflammation, treatment by drainage and by abdominal extirpation, followed by a chapter on Chronic Pelvic Inflammations.

There has been much discussion on the subject of conservative surgery of ovarus and tubes in which Dr. Crossen takes a prominent part, while the discussion is not closed very material progress has been made in recent years, what Dr. Crossen presents is clearly the last word.

The remainder of this important book is devoted to miscellaneous gynecologic affections.

PHYSIOLOGY AND BIOCHEMISTRY IN MODERN MEDICINE

By J. J. R. Macleod, M.B., Professor of Physiology in the University of Toronto, Canada; Formerly Professor of Physiology in the Western Reserve University, Cleveland, Ohio. Assisted by Roy G. Pearce, A. C., Redfield and N. B. Taylor and Others. Third Edition, with 243 Illustrations, Including 9 Plates in Colors, 992 Pages of Text. C. V. Mosby Company, St. Louis, 1920. Price $10.00.

Dr. Macleod in the preface indicates the purpose of this important book. "Modern Medicine is based on the correlation of laboratory and clinical studies." The author is inclined to criticise the failure of some teachers of medicine to make this fact clear and bring together laboratory study in clinical interpretation. The occasion for this criticism is becoming less and the applications of laboratory studies to clinical medicine is finding a fuller expression in group methods of practice whereby the laboratory man and the practitioner are coming together.

The book before us is not a laboratory manual

but a work for the physician who appreciates the value of physiology as preliminary to a study of pathologic conditions. As an illustration we may refer to the blood and lymph and the circulation of these fluids, 215 pages are devoted to this subject. Blood, general properties, quantity of blood in the body, ferments and anti-ferments; blood corpuscles, congulation of blood; general considerations; lymph formation and circulation; cerebrospinal fluid; circulation of blood; mean arterial blood pressure; viscosity of the blood; elasticity of vessel walls; action of the heart; pumping action of the heart; mechanism of opening and closing of the valves; heart sounds; nutrition of the heart; physiology of the heart-beat. The blood flow in the arteries; the pulse and characteristics, pulse curves; rate of movement of blood in the blood-vessels; work of the heart; the output of the heart per beat; the control of the circulation; nerve control of the peripheral resistance; control of the vasomotor center; capillary circulation; peculiarities of the blood supply in certain viscera. Then follow the clinical application of certain physiological method, electocardeograms; interpretation, 176 pages are devoted to the study of the circulation, 136 pages to respiration. It will be seen from the above illustrations the general trend of the work which may be extended to other systems of the body and to what extent physiology and biochemistry relates to clinical medicine.

A SHORT HISTORY OF NURSING FROM THE EARLIEST TERMS TO THE PRESENT DAY

By Lavina L. Dock, R.N.; Secretary, International Council of Nurses, in Collaboration with Isabel Mailland Stewart, A.M., R.N.; Columbia University, New York. P. P. Putnam's Sons, New York and London. Price $3.50.

This book should appeal to a wide range of readers who are interested in the cultural side of nursing; physicians, nurses and educated people generally. After an introduction, the author traces an outline of the care of the sick in the ancient world; through the influences of Christianity in the care of the sick, the aristocratic and military influences in the care of wounded soldiers, the democratic and secular influence from the time of Abelard to Ambrase Pare and Vesalius. The dark period in nursing from the breaking up of monastic charity, incident to the Reformation. In Protestant countries the suppression of the monastic orders, where charity and nursing had been an important influence, no attempt was made to supply the lack of care for the sick poor. The deterioration of nursing in Protestant countries was also observed in Catholic countries. The condition in nursing was comparable with the condition of education during this period.

We commence again with the appearance of Florence Nightingale. Then comes nursing in American, with the Spanish and French hospitals, under the

direction of Catholic Sisters, and later, the training courses under Catholic and Protestant religious orders. The training schools of hospitals, and the independent training schools. Chapter nine brings us to the modern extension of nursing. First private duty, second hospital service, third visiting nursing, which is considered in considerable detail. Then comes a chapter on educational development in a wider sense in educational and institutional relationship. The author reviews nursing in other countries. The book closes with a review of the past and a vision of the future.

The evolution of nursing goes hand in hand with the evolution of the races of men, of humane aspirations in the different ages of the world, gains momentum with the development of medical science and practice and will in the future, advance with the needs of the world, the advancement of medicine, and the higher standards of hospitals. This book should be in the hands of all interested in humane progress.

GEORGE MILLER STERNBERG, A
BIOGRAPHY

By His Wife, Martha L. Sternberg. Amer-
ican Medical Association, Chicago.

In the November number of the Journal, we presented a biographical sketch of former Surgeon General Sternberg, prepared by the Journal of the American Medical Association, we now have the pleasure of reviewing a biography of the General by his wife who presents to the world a record of his work as a man and a public servant.

We have a brief outline of the events of his early life. In October, 1865, Dr. Sternberg married Miss Louisa Russell of Cooperstown, N. Y.; following this event we have now a record of Doctor and Mrs. Sternberg's experiences. First at Jefferson Barracks and then at Fort Harker, Kansas which at one time was a frontier post. Following one assignment after another, brought Dr. Sternberg to Fort Barraricas, Florida, where he served three years, suffered an attack of yellow fever which was near being fatal. After a leave of absence of six months, he was assigned to the Department of Columbia in 1876.

Conditions were comparatively new but very interesting; Mrs. Sternberg describes their life and experiences during the three years in this department. In 1879 Surgeon Sternberg was ordered to Washington to take up his duties as a member of the Havana Yellow Fever Commission, which with other scientific work continued up to 1893 when he was appointed surgeon general of the army. Dr. Sternberg's work during this period is described by his wife in a most intimate and interesting manner. social relations after his appointment to this high office is dwelt on. This was during Mr. Cleveland's second term and the first part of Mr. McKinley's term up to the breaking out of the Spanish American War. Serving as medical advisor in both Cleveland

The

and McKinley families furnished a social experience of rare interest.

The condition of unpreparedness which has found us in all wars, brought great difficulties to the surgeon general's office, which Mrs. Sternberg faithfully portrays and which is now vividly recalled when our recent experiences are so fresh in mind.

Surgeon General Sternberg and the medical department of the army could not of course escape criticism for faults that belonged to the nation, and the wife's viewpoint is presented in a quiet and judicious manner fortified with facts, which are now fully admitted. Some space is given to the Walter Reed commission which operated under the direction of the surgeon general.

Surgeon General Sternberg retired from the army June 8, 1902, and the remainder of the book is devoted to scientific achievements and humanitarian interests. This part of the book is full of interest as an appreciation of the man who in a long life of usefulness served his country with distinction and conferred upon the army great honor.

The book is a valuable contribution to our knowl edge of army medical activities which covers the pe riod of discovery of the nature and origin of infectious diseases and marks a new era in medical knowledge.

THE SURGICAL CLINICS OF CHICAGO Volume IV, No. 4, with 80 Illustrations, August, 1920. Published Bi-Monthly. W. B. Saunders. Price Per Year $12.00.

This number contains clinics by seventeen different surgeons including thirty-two subjects. It is interesting to observe that since the publication of the Chicago Surgical Clinics, new groups of surgeons are appearing, although we still recognize Dr. Ochsner, Bevan, Eisendrath and Kanaval. The later groups represent the surgery of the various Chicago hospi tals of today and bears witness to the changes in personnel in the profession. The clinics fairly represent the surgical progress in Chicago.

CARE AND FEEDING OF INFANTS AND

CHILDREN

A Text-Book for Trained Nurses, by Walter Reeve Ramsey, M.D., Associate Professor of Diseases of Children, University of Minnesota, Associate Visiting Physician of the University Hospital. Including Suggestions on Nursing by Margaret B. Lettice, Supervising Nurse of the Baby Welfare Association, St. Paul, Minnesota; 123 Illustrations, Second Edition, Revised. J. B. Lippincott Company, Price $2.50 Net.

We are presenting one of Lippincott Nursing Manuals which is a very attractive book and contains much of particular interest. It is well adapted to advanced communities where health and welfare (Continued on Advertising Page xviii)

BOOK REVIEWS

(Continued from Page 74)

work is well developed. It is beginning to be felt that the mother and the prospective mother are to be considered, particularly is this true in industrial centers.

In agricultural communities where the conditions are relatively normal the mortality among children is small but in cities among the lower classes, conditions are quite different and the child welfare nurse and the school nurse have important functions and to meet the need the Lippincott Company has rendered an important service in publishing manuals covering subjects that are the most essential for the better instruction of the nurse who may be engaged in welfare work. These manuals are not elementary primers but are really scientific and presume a certain amount of training, and will impart a feeling of personal dignity to the nurse who will find it worth while to read and study these books carefully. The above observations apply to the book before us. We shall not undertake to mention in detail the contents of this book, we have already suggested its value.

INTERNATIONAL CLINICS

A Quarterly of Illustrated Clinical Lectures and Especially Prepared Original Articles on Treatment, Medicine, Surgery, Neurology, and the Various Branches of Medicine and Surgery. Edited by H. R. M. Landis, M.D., Philadelphia, Volume 2, Thirteenth Series, 1920. J. B. Lippincott Company.

The International Clinics have become so well known and now reach so many readers that it has become possible to secure clinical contributions from the foremost practitioners of this country and abroad.

The special merit of these volumes consists in the practical character of the papers covering the ground in which the general medical profession is interested.

The publishers have been particularly alive to the changing features of the work that is being done by the men who have to deal with the great problems of the medical profession. If the volumes of the series are examined, a history of the advance of modern medicine can be easily followed.

NEW AND NON-OFFICIAL REMEDIES

During September the following articles have been accepted by the Council on Pharmacy and Chemistry for inclusion in New and Non-Official Remedies: United Synthetic Chemical Corporation:

20 per cent Aromatized Suspension made from Benzyl Benzoate (Van Dyk and Co.). The Heyden Chemical Works:

Proganol.

Change of Agencies:

Arheol and Riodine. The Council has directed that the description of Arheol (New and NonOfficial Remedies, 1920, p. 251) and Riodine (Jour. A. M. A., August 14, 1920, p. 477) be revised to state that these products are manufactured by P. Astier Laboratories, Paris and New York, and are distributed by Geo. J. Wallau, Inc., New York.

Benzyl Alcohol (Van Dyk and Co.): Benzyl Benzoate (Van Dyk and Co.): The Council has directed that the description of Benzyl Alcohol-Van Dyk and Co., (New and Non-Official Remedies, 1920, p. 28), and Benzyl Benzoate— Van Dyk and Co., (New and Non-Official Remedies, 1920, p. 50), be revised to indicate that the United Synthetic Chemical Corporation is the distributor of these products.

Official Articles not Within the Scope of New and Non-Official Remedies:

Capsules Folia-Digitalis (Upsher Smith): Tincture of Digitalis (Upsher Smith): These products are sold by Upsher Smith, St. Paul, Minnesota. The Council finds that they have the status of official articles and are, therefore, not within the scope of New and Non-Official Remedies:

NEW SURGICAL SUNDRY CATALOG

Special attention is called to the advertisement of the Standard Chemical Company on page ten of this issue regarding their new catalog of surgical sundries which is now ready for distribution.

This catalog contains 160 pages of illustrations, prices and descriptive matter of carefully selected articles, known as surgical sundries, now in general use by the medical profession. These items have been divided into nine different sections properly classified, and will be found a ready reference book.

Members of the profession are urged to write for a copy at once as only a limited number of catalogs is available for general distribution.

POST-GRADUATE COURSES FOR PRACTITIONERS Offered by

WASHINGTON UNIVERSITY SCHOOL OF MEDICINE St. Louis, Mo.

Post-graduate instruction will be offered, beginning April 4, 1921, in internal medicine, general surgery, obstetrics and gynecology, pediatrics, orthopedic surgery, genitourinary surgery, neurology, dermatology, ophthalmology, laryngology and rhinology, otology, anatomy, and current medical literature. Courses run from four weeks to one year; fees range from $25 to $500. For full information, address

THE DEAN, WASHINGTON UNIVERSITY SCHOOL OF MEDICINE St. Louis, Missouri

VOL. XI

BRAIN INJURIES*

No. 3

tempts at analysis. To be sure, they defined the symptoms immediately noted rather accurately,

Within the past few years, almost every operation in the entire domain of surgery, has been standardized, except the surgery of the head.

There exists a wide range of opinion concerning operative indications for the surgery of the head, which is no less confusing than the opinions of operators suggesting technic for the treatment of the commoner conditions of brain injury demanding surgical care and attention.

Seemingly, it is evident, from quite an extensive reading upon the subject of brain surgery, it requires very often exceptional good judgment to know just when to not operate upon the head, and it is also somewhat perplexing to know that the procedure contemplated gives promise of the best obtainable result.

Refined methods of diagnosis are being constantly contributed to literature by the workers in this branch of surgery, and the fruit of their experience constantly changes the indication for operative interference.

Owing to the anatomical fact that the brain is an exceedingly vascular organ, and that it is enclosed in a tough fibrous membranous capsule, and that all is confined within an inflexible bony box of fixed capacity, the brain is subjected to a variety of different pathological conditions than are not encountered elsewhere in the body.

Almost any injury of even moderate severity to the head, immediately presents three strikingly separate and distinct conditions. Contusion of the scalp, which is a composite tissue. trauma to the skull, which is inflexible; and vascular disturbance of the brain.

Either or all of these conditions may require surgical care, but the most important of these injuries is the trauma of the brain which commonly is urgent, by demands of surgical care.

The time honored classification of concussion; contusion and compression were indefinite at*Presented at the Sixty-Ninth Annual Session, Iowa State Medical Society, May 12, 13, 14, 1920, Des Moines, Iowa.

edge of the pathology of brain injuries, they are woefully lacking in conveying an understanding

of the extent, immediate, or remote of the trauma of the brain.

There cannot well, be a defined line dividing the cases of simple traumatory unconsciousness due to injury, and concussion, no more can there be a distinct border line established, when the brain that has suffered concussion, passes to the secondary stage and by reason of oedema or hemorrhage becomes a case of compression.

The conditions of contusion, are more readily recognized, by the intensity of all the symptoms, and an observing attendant may anticipate the compression period and can with reasonable accuracy foretell its occurrence.

Usually in severe head injuries, concussion merges into a state of compression; especially is this true where the structure of the brain has been damaged, or where hemorrhage has occurred.

The following history conforms rather accurately to the usual clinical course.

A young man was knocked down on the street by an automobile, when assistance reached him he was

dazed, but was able to stand and with help walked

to a nearby house where an ambulance was called and within twenty minutes he was removed to the hospital.

About the time the ambulance arrived his dazed state had passed and he became violently excited and greatly agitated, this was the classical evidence of concussion. Within an hour after reaching the hospital he vomited several times and complained bitterly of headache which was accompanied by a slowing of the pulse, with an increased tension and a dilatation of the pupils, occuring bilateral. This condition was caused by the swelling or hemorrhage and a state of compression was plainly evident.

A skiagram showed a fissure fracture of the left parietal bone just above the parietal eminence. A button of bone was removed which centered over the line of fracture and an extra-dural and sub-dural haematoma was found under the fracture line. The extradural clot was removed but the dura was not