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graduated before the advent of the germ theory, also will prove a valuable text-book in the hands of the medical student.

Chapter III. of Part I. on Immunity and Susceptibility is particularly interesting.

ELEMENTARY Bandaging and SURGICAL DRESSING, with directions concerning the immediate treatment of cases of emergency. For the use of Dressers and Nurses, by WALTER PYE, F.R.C.S., Late Surgeon to St. Mary's Hospital. Revised and in part re-written by G. BELLINGHAM SMITH, F.R.C.S., Surgical Registrar, Guy's Hospital. Seventh edition. W. B. Saunders, 925 Walnut Street, Philadelphia. 1897. This pocket edition, the seventh edition of the work, has long been a favorite manual with dressers and nurses. It is a multum in parvo book, and will doubtless continue to grow in popularity.

THE PHYSICIAN'S VEST-POCKET FORMULA BOOK, published by McKesson & Robbins, will be found very useful to the prac titioner. It contains a table of weights and measures, antidotes. to poisons, various tables of reference, and a very complete series of tables, showing the composition of foods and alcoholic liquors. These tables should prove valuable to the physician in cases where special attention to dietary is necessary. The book also contains an extended series of notes on some of the new pharmaceutical preparations and a complete list of formulae of the McK. & R. Gelatine Coated Pills. A copy will be sent free of charge to any of our readers on application to McKesson & Robbins, 91 Fulton Street, New York.

Publishers' Department.

PEPSIN is undoubtedly one of the most valuable digestive agents of our materia medica, provided a good article is used. Robinson's Lime Juice and Pepsin, and Arom. Fluid Pepsin (see advertisement is this number) we can recommend as possessing merit of high order.

The fact that the manufacturers of these palatable prepara. tions use the purest and best Pepsin, and that every lot made by them is carefully tested before offering for sale is a guarantee to the physician that he will certainly obtain the good results he expects from Pepsin.


A-ll the nerves are gone on a bender,
N-ot an organ is exempt,

T-eeth and scalp and muscles tender,
I-cy chills, the bones pre-empt;
K-aleidoscopic are the symptoms legion,
A-s they over-run the system,
M-aking life a weary region,
N-o one able to resist them,

I-s there nothing that will cure?
A-ntikamnia will, I'm sure.

Atlanta, Ga.


LACTOPHENIN.-Pediatrics (March 15, 1897) quotes from a "Report on New Remedies," by Dr. P. Phillip (Archiv. für Kinderheilkunde) :

"Stein, Strauss, Schlutius and Riede publish their experience with lactophenin. Its sedative qualities, which make it useful, particularly in typhoid fever, are praised by most of its friends. According to Stein it may be used wherever phenacetin is indicated. Because of its relative safety and possibility of longer use it is much superior to phenacetin. Riede calls it a specific in acute articular rheumatism, producing no ear-symptoms or depression of the heart, as does salicylic acid and salophen."

This summary of the therapeutic value of lactophenin has been variously confirmed by clinical reports during the past year from sources widely apart. We note, for instance, in a report on "Treatment of Typhoid Fever in Children," by Dr. F. Gordon Morrill, Visiting Physician at the Children's Hospital of Boston, Mass. (in Archives of Pediatrics, March, 1897) that lactophenin is used in that institution, and that 3 to 8 grain doses "are very effective, and do no harm, as far as my experience goes;" lactophenin produces a drop of 3.5° F. in four hours, according to careful records. "Restful sleep may often be obtained in this way."

I HAVE prescribed Bromidia with pronounced success in several cases of nervousness and restlessness, and in one case of acute cystitis. I have combined Papine with Bromidia which gave instant relief. Parenthetically, I may say I have personally used a teaspoonful of Bromidia, after having successively lost several nights' rest and procured a refreshing night's rest with no bad after-effects. CHAS. E. QUENTIL, M.D.

Philadelphia, Pa., Feb. 23, 1897.






JUNE, 1897.

Original Gommunications.




Operations for the relief of stone in the bladder have undergone a radical change in the last twenty years. In 1878 Bigelow, of Boston, brought the notice of the profession to a new method of crushing stones in the bladder and removing the fragments by aspiration at one sitting. This new procedure, termed by its originator litholopaxy, has, to a certain extent, revolutionized practice in this important branch of surgery. Stone cases, formerly invariably submitted to cutting operations, are now relieved by Bigelow's method. As regards the frequency with which the two methods, cutting and crushing, are now employed in the treatment of vesical calculi, there can

Prepared for the Sixty-fourth Annual Meeting of the Tennessee State Medical Society, held in Nashville, Tenn., May 11, 12, and 13, 1897.

be no question but that the latter is considerably in the ascendancy. Surgeons are generally unanimous that in properly selected cases litholopaxy yields the best results as regards life, but, at the same time, recognize the fact that there is a distinct limitation of the field of usefulness of that method. Certain cases of stone are unfit for litholopaxy, as even the warmest advocates of that method will admit; as for instance, large calculi, very hard calculi of the oxalate variety that resist the breaking force of the best constructed lithotrites, stones lodged in bladders seriously damaged by pathological changes, cases of advanced urethral stricture, encysted stone, greatly hypertrophied prostate gland, etc. There is, on the contrary, no limitation to the cutting operations. Every case of stone in the bladder may be operated upon by one of the several methods, the character of the operation being determined by circumstances. The mortality rate of the opposed procedures does not vary sufficiently to determine that one method is superior to the other.

The assertion now, not infrequently made, that lithotomy, supplanted by its old rival in modern shape, will sooner or later become an obsolete procedure cannot be true. Granted that the supremacy of lithotomy in the field of stone operations exists no longer, that method of dealing with that class of diseases will always be demanded in certain cases. What cases are best suited to the crushing, and what to the cutting operations must be regulated partly by the circumstances surrounding each individual case, and partly by the predilection of the surgeon. I maintain, therefore, that lithotomy cannot be put aside as a useless surgical procedure. There is no danger of it becoming a "lost art in surgery." A certain class of stone cases can be relieved by no other method. Lithotomy, in one of its forms, will continue to hold an important place among surgical procedures as long as surgery exists. Even the most skillful and pronounced litholopaxist is forced to admit that certain conditions demand the performance of lithotomy. Individually, my preference is for lithotomy in nearly all cases requiring surgical interference on the grounds that it is more surgical and that it is not more dangerous to life. Blind surgery is bad surgery, is an axiom that, in my opinion, may be applied to litholopaxy.

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