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Miss Cocroft evidently belongs to the "don't-worry club" and insists strongly on the necessity of mental repose for the attainment of physical health. But in other ways, too, her advice is sound: "A wellpoised mind finds its physical expression in head erect, the back of the neck nearly straight, the shoulders level, the chest and lungs well developed, the spine nearly straight to the waist, and the hips well back-the whole being expressing uprightness, a tendency to reach upward, to lift one's very being to the heights-this is the expression of freedom, mental, moral, and physical." Verily, physicians might properly pay a little more attention to mental repose, and might learn some valuable and useful lessons from socalled irregular practitioners and "physical culture cranks" (save the mark!).

BARNESBY'S "MEDICAL CHAOS AND CRIME"

Medical Chaos and Crime. By Norman Barnesby, M. D. Mitchell Kennerley, London and New York. 1910. Price $2.00.

For a long time we could not bring ourselves to read this book through, and cannot to this day see the raison d'être of such a publication. If it is intended for the public, it is muck-raking of the worst kind, because it would then tend to discredit the medical profession at large, through the sins of the few, to a degree and extent which in its ulterior consequences would needs have to reflect unfavorably on the health of the public; since, after all, physicians (and by physicians we mean the regular profession) are the proper guardians of the public health.

If the book was intended as a warning cry to the profession, it was needless, because, as has been pointed out in The Critic and Guide some time ago, almost all the evidence which the author collected with a zeal and energy worthy of a better object was taken from medical publications, showing that the profession is entirely and fully awake to the existence of the black sheep within its fold and that the seriousminded and honest members of the profession are doing their best to improve

irregularities and to weed out, not only the unfit, but also the unworthy.

It, then, appears to follow that the book belongs to that class of publications which would better not have been written, and, frankly, we have a strong suspicion that the ulterior motive was not an entirely disinterested one, whether for financial reasons or from the desire for notoriety. We absolutely fail to see how a book of this character can do any good.

The evils which are pointed out are well known, are best known to the profession, are discussed and condemned, and the men who are guilty of them are made to feel that they are guilty. It is unfair to single out one class of men who, in the vast majority of its members, are upright, honest and sincere physicians, and to condemn them as a class for the sins of the very, very few.

The gentle art of muck-raking is rather a contemptible pastime, and we sincerely wish that the book had never been written, and having been written, that it had not found a publisher.

ACHARD.

FORD'S "REGIONAL ANATOMY”

Handbook of Regional Anatomy. By Francis C. Ford, A. B., M. D. Published by the author. Chicago. 1910 (1216 Masonic Temple). Price $1.50. A useful work, containing much information in small compass.

LOWRY'S "TRUTHS"

Truths: Talks with a Boy Concerning Himself. By E. B. Lowry. Chicago: Forbes & Co. 1911. Price 50 cents net.

This is a companion volume to "Confidences; Talks with a Young Girl Concerning Herself," and attempts to do for the growing boy what "Confidences" accomplishes for his sister.

MUSSER-KELLY'S "PRACTICAL

TREATMENT"

A Handbook of Practical Treatment. By Many Writers. Edited by John H.

Musser, M. D., LL. D., and A. O. J. Kelly, A. M., M. D. Vol. I. Philadelphia: W. B. Saunders Company. 1911. Price, cloth, $6.00 net.

To judge from the list of contributors, this handbook, which is to consist of three volumes, will form one of the most valuable additions to the physicians' libraries. Particular stress is laid on the various chapters upon the practical phases of the subjects considered; for while, as the authors say in the preface, there is in medicine an art and a science, the practising physician's chief concern is with the art rather than the science. His preeminent function is to preserve or prolong life and to mitigate suffering. His major interest is centered in the practical treatment of disease, all else conducing thereto (etiology, pathology, diagnosis) being tributary, a means to an end. Quoting from the Preface:

"The fore part of the work is devoted to a discussion, from a general viewpoint, of various therapeutic measures; the latter part, to the special treatment of the many general and local diseases. The subjects discussed from a general viewpoint comprise prophylaxis, diet, drugs, exercise, massage, mechanotherapy, psychotherapy, hydrotherapy, balneotherapy, climatotherapy, aerotherapy, electrotherapy, and radiotherapy, as well as other miscellaneous, well-known and justly prized therapeutic measures; but, in addition, emphasis has been laid upon certain sorts of specific therapy, which, resulting directly from painstaking scientific study and investigation, especially in the domain of pharmacology and chemistry, have enhanced the art of medicine and materially augmented the resources of therapeutics-such as organotherapy, serum therapy, bacteriotherapy, vaccine therapy, and chemotherapy."

The 909 pages of the first volume contain 23 chapters discussing as many different subjects, such as prophylaxis, dietetics, drug treatment, serum therapy, organotherapy, electrotherapy, radiotherapy, climatotherapy, etc., so that it is practically impossible to review the volume as a whole. However, the reviewer was particularly interested in the introductory chapter by

Dr. Musser, on The Fundamental Principles of Therapeutics.

The author, in this chapter, discusses in a masterly and attractive manner the nature of disease and the mechanism of the organic resistance to disease or to the agencies which may be productive of disease. From a consideration of the biologic defense set up by the organism against anything that may exert an injurious action upon it, he passes on to a description of the morphologic and the physiologic expressions of disease and to the exogenic causes of disease. The defense of the organism is discussed in a particularly interesting manner, and the discussion is certain to assist the physician greatly in obtaining a clearer conception of the fundamental principles underlying the production and course of disease from which the means taken to combat it may be elaborated. The aids to the defenses of the organism which are then discussed form a general dissertation on therapeutics, and Dr. Musser's conception of treatment is attractive, to say the least.

The modern researches, not only in physiology and pathology, but still more in biology, have solved so may problems and have given us such a beautiful insight into the workings of the normal as well as of the diseased organism, that the problem of treatment of disease no longer constitutes merely a question of what drugs to prescribe or what mechanical agent to employ. The task has become a much larger one, but we are correspondingly better enabled to meet conditions which we find and to assist the organism in restoring physiological or normal conditions, thereby to remove the cause of disease and eventually the disease itself, i. e., to cure it. For the accomplishment of this end this work offers an excellent guide the careful and continued study of which must immensely benefit ourselves directly and our patients mediately.

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This is an important contribution to medical literature, the more so as the author, to quote from the preface, has "attempted to keep in the background the rare diseases which are of so much interest to the specialist and to give prominence to the common affections usually met by the general practitioner." In this attempt he has fully succeeded. The usefulness of the book is increased by chapters on diagnosis of the diseases of the bladder, the rectum, and the breast. These affections often are closely linked with strictly "gynecologic" disturbances and are justly included in the textbook, which is designed as a clinical guide for the general practitioner. A further important chapter is that on constipation, the treatment of which is excellently given.

A Text-book on the Practice of Gynecology, for Practitioners and Students. By William Easterly Ashton, M. D., L. D. With 1058 new line drawings illustrating the text, by John V. Alteneder. Fourth edition; revised and enlarged. Philadelphia: W. B. Saunders Company. 1910. Price, cloth, $6.50.

Ashton's "Gynecology" does not need an introduction. It is sufficient to announce that a new enlarged edition has appeared. Some of the additions are interesting, as for instance the employment of magnesium-sulphate solution in erysipelas of the vulva, the appreciation of straight-front corsets against the harmful old-fashioned forms. The author's technic of giving colonic flushings is interesting. The book is very complete, presenting, from all possible points of view, the diseases peculiar to women and considering both medical and surgical procedures treatment.

of

Diagnosis and Treatment of Diseases of Women. By Harry Sturgeon Crossen, M. D. Second edition, revised and enlarged. With 744 engravings. St. Louis: C. V. Mosby Company. 1910. Price, cloth, $6.50.

The author's endeavor has been to present clearly and in detail the foundation facts and principles of gynecology, collecting in one volume the anatomic, pathologic, diagnostic, and therapeutic in

formation underlying successful gynecologic work.

Two hundred pages of text and fifty original illustrations have been added. The index, upon which the practical usefulness of a medical book so largely depends, has been greatly amplified, so as to include references and cross-references to every diagnostic and therapeutic item. In the new text special attention has been given to the presentation of pelvic inflammation and of tubal pregnancy-two live and important subjects, upon each of which an enormous and chaotic mass of information has accumulated. Properly to emphasize the established landmarks and to point out important features of advance work, such was the task. Disturbances of function merit, and have received, careful and detailed consideration, both from the diagnostic and therapeutic stand point.

Medicolegal complications are claiming more and more attention each year, and those having a bearing on gynecology are considered in a detailed and practical way.

LIPPINCOTT'S "INTERNATIONAL

CLINICS"

Among articles of immediate interest in "International Clinics," Vol. I, 21st Series, 1911 (J. B. Lippincott Company. Price $2.00) are the papers on Pellagra, by Zeller; "606," by Wechselmann; Poliomyelitis, by Mills, and Neff; Raynaud's Disease, by Beck; and Mosquito Work in the Canal Zone, by Le Prince. Reilly's chapter on the treatment of typhoid fever is less satisfactory. Ostheimer contributes a useful and up-to-date article on Modern Infant Feeding. Mills actually devotes two and a half pages to the treatment of poliomyelitis, telling of a number of expedients he has found to be of little or no

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While the editors make replies to these queries as they are able, they are very far from wishing to monopolize the stage and would be pleased to hear from any reader who can furnish further and better information. Moreover, we would urge those seeking advice to report the results, whether good or bad. In all cases please give the number of the query when writing anything concerning it. Positively no attention paid to anonymous letters.

QUERIES

QUERY 5713.-"The Radical Cure of Hemorrhoids." G. T. S., Texas, wants to know what is the best operation, in a country practice, for the removal of hemorrhoids.

We have several times, in the past few years, recommended strongly the injectionmethod, pointing out clearly the effectiveness and simplicity of the procedure and absence of danger. Most failures reported in the past have been due to imperfect technic or the use of too weak or complex solutions. We have yet to see the patient who does not prefer injection to excision or the ligature, and if the work is properly done, there is no detention from business or pain worth mentioning. Many men go straight from the office to their work and never lose an hour's time.

However, all piles are not suitable for injection. External piles should be incised and the clot turned out. If the tumor is of any considerable size, a stitch or even two may be used to close the incision. Inflamed mucous tags should be snipped off.

Few practicians care to use the knife, while the clamp and cautery are out of the question. The ligature, properly applied, is infinitely preferable to this procedure. However, considerable pain follows even the most skilful use of the ligature, and retention of urine is not infrequently noticed. Of course, you are familiar with the details of this slight operation, and, occasionally, pedunculated tumors are encountered which may advantageously be tied off. Such tumors, however, in the writer's opinion, should be removed with the scissors after

the ligature has been firmly tied. The mucosa in every case should be incised and the ligature placed exactly in the incision. If any hemorrhage follows, which is rare, the stump may be touched with pure carbolic acid.

During the past five years the writer has injected practically all internal hemorrhoids coming under treatment, using a strong solution of carbolic acid in olive oil or purified sperm oil, in the proportion of 3 to 2, making sure of a pure product. (Merck's or Mallinckrodt's have proved thoroughly satisfactory.) The mixture should be warmed before injection and the syringe thoroughly sterilized in boiling water. When adding the crystallized carbolic acid to the oil, liquefy by heat. Some operators use glycerin as a diluent, but, in the writer's opinion, the latter is too hygroscopic to prove satisfactory. The addition of glycerite of lead, or of ergot, hydrastin, tannic acid, to the solution is undesirable. Unquestionably the best results follow the intelligent use of the formula mentioned.

The practician should realize that cleanliness is of primary importance, and only enough fluid should be injected thoroughly to coagulate the contents of the tumor. The external parts should be cleansed with soap and an antiseptic, then swabbed with alcohol.

Lubricate the canal, and, if any constriction of the sphincter ani exists, dilateif necessary, under primary anesthesia. The patient should now be placed on the side opposite to that on which the piles are located and the speculum inserted

gently, the Brinkerhoff or Matthews being perhaps the best for the purpose. The tumor to be operated upon should project downward through the opening in the speculum when the slide is withdrawn. The patient should strain at this point and the operator make quite sure that the entire tumor is in view.

Fill an all-glass syringe, of a capacity of 20 minims, with the fluid, attach a 20- or 22-gauge (or slightly coarser) needle (the exact size of the needle is immaterial providing it is not less than an inch long and permits the free exit of the fluid); elevate the syringe, express a small quantity of the fluid, wipe off the needle, lubricate the hemorrhoid with carbolated vaseline, and quickly thrust the needle into the pendent tumor half way between the base and apex. The point of the needle should not penetrate further than to the center of the hemorrhoid. Inject the fluid drop by drop, gradually changing the direction of the point and withdrawing it slightly as the tumor whitens. As soon as the tumor is blanched and hard, the needle may be withdrawn slowly, a last drop of carbolic solution being deposited just within the mucous coat. It takes five minutes, as a rule, thoroughly to treat an ordinary hemorrhoid. If on withdrawal of the needle blood follows, more of the solution must be injected, the needle preferably being inserted at another point.

Some hemorrhoids are multilocular and a portion of the tumor remains unblanched by the injected fluid. In such cases the needle must be inserted into the unaffected cavity (it is usually small) and a few minims of the carbolic solution injected. The largest tumors can be destroyed with 20 minims of a strong oil solution of carbolic acid properly injected. Weak solutions and punctures of the intestinal wall have caused nine-tenths of the failures.

If the operation is properly performed, the entire tumor up to its base will now be white and hard. Two or three ordinarysized hemorrhoids may be injected at one sitting, preferably those upon one side of the intestine. The bowel should finally be well lubricated with a soothing ointment or antiseptic oil and then kept inactive

for twenty-four hours. After this period a purge should be given and the patient instructed to inject, before going to stool, an ounce or two of olive oil, which may contain a minim or two of carbolic acid or other antiseptic. Carbenzol or a similar ointment may be used advantageously. After stool the bowel should be thoroughly irrigated with salt water and more of the ointment inserted; preferably with a rubber "pile pipe," warm.

Rarely a patient complains of pain; if he does, a suppository containing extract of hyoscyamus or a little morphine may be ordered. Ninety patients out of a hundred require no attention whatever and follow their usual vocations.

If the tumors injected have been large and proctitis coexists, the patient should remain in a recumbent position for a day or two after injection. The bowels should be kept lubricated, a hot enema following each stool. Phenolphthalein and compound licorice powder, in the proportion of 1 grain to 5, if given at bedtime, will produce a soft, mushy evacuation next morning. From 10 to 20 grains is the dose for an adult.

Theoretically, small tumors should be injected first, but as a matter of fact, if one or two large hemorrhoids are injected, the smaller ones usually disappear spontaneously. Hydrastin, hamamelin, and esculin, 1-3 grain each, should always be given three or four times daily.

In very rare cases secondary hemorrhage occurs. This can be controlled by packing the rectum with gauze smeared with an ointment containing an extract of suprarenal gland, or a fairly strong solution of hydrastin and thuja may be injected. The deep ulceration which has been complained of by some operators never appears unless the fluid had been injected into the bowel-wall. There is no excuse for such an "accident," and if the technic outlined herewith is followed closely, the tumor will drop off without the occurrence of suppuration or any marked inflammatory symptoms.

It is hardly necessary to point out the desirability of thoroughly opening the bowels a day or two prior to the operation.

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