661

In very severe cases we are told that in most circumstances hu

the best course is to rupture the membranes immediately chwith a finger or a bougie, and yet a little further down the !

same page is the statement: "Early rupture of the mem- opbranes is widely employed in the treatment of ablatio an

placentae, but there is little doubt that the results following pr:its application are not such as to justify its routine use." haAbdominal Caesarean section is mentioned but not the per- of

formance of Porro’s operation, a much more suitable pro-cedure in such cases of emergency. The book is well illustrated and bound but the index

is by no means so complete as it should be in a work ofthis size. There is much in the volume which will be readwith profit by both student and teacher, but we doubtif the former will find it as useful as it might be as a workof reference when he is confronted with a difficult case inactual practice. Although he will have no reason to com-plain of the number of different plans of treatment referredto he will not receive as much assistance from the author

in enabling him to form a definite choice between them as tlhe might well expect, and it must be remembered that this

tlis one of the main objects with which a young practitioner consults a text-book.

im

A. Manual of Operative Surgery. By Sir FREDERICK TREVES, Bart., K.C.V.O.. C.B., LL.D.Abe-d., F.RC.S. h

Eng.; Sergeant Surgeon-in-Ordinary to H.M. the King;Surgeon-in-Ordinary to H.R. H. the Prince of Wales; Con- ilsulting Surgeon to the London Hospital. New edition, prevised by the Author and JONATHAN HUTCHINSON,Jun., F.R.C.S. Eng. ; Surgeon to the London Hospital ; uExaminer in Surgery, Royal Army Medical Department. a

With upwards of 470 Illustrations. In two volumes. v

London, Paris, New York, and Melbourne: Cassel) and CCompany, Limited. 1903. Pp. 750 and 824. Price 42. E

THE first edition of this well-known work was published I

in 1891 and three issues have appeared since then, but I

the very considerable changes that have been made in v

operative surgery required that the book should be entirely revised. This has been done and judging by the result iwe consider that Sir Frederick Treves has been wise in selecting as his coadjutor for this arduous duty Mr.Jonathan Hutchinson, jun. The distinguishing charac- ‘teristic of the first edition of this Operative Surgery" was the limitation of the modes of operation presented tothe reader to those which in the author’s opinion were themost valuable. In many ways this is an excellent method,for so far as the student is concerned his memory is not

overweighted with a variety of different modes of attainingthe same result, and so far as the surgeon is concernedthe burden of choice is laid on the author of the volume andnot on the reader. This is as it should be for a work intended

chiefly to be used by surgeons who have not had a veryextended experience and yet have to act on their own

responsibility, perhaps in out of the way parts of the world.We consider that the book will be found useful by surgeonsof cottage hospitals and medical officers of the navy and

army who have to depend on themselves in carrying outoperative procedures. Just that form and amount of assist-ance which they need will be given them by this work andto this end we commend it.

The very essence of the book is its practical nature. Itis hardly possible to open it at random and to read a pagewithout recognising that the author is describing a subjectwith which he himself is thoroughly acquainted and that hehas an exceptional power of imparting to others the know-ledge which he possesses. Very pertinent are the remarksin the chapter on the operator, from which we may quote :"A shakiness of the hand may be some bar to the successof an operation, but he of a shaky mind is hopeless. In the

handling of a sharp instrument in connexion with the

human body a confusion of the intellect is worse thanchorea."

Sections are devoted to the preparation of the patient foroperation and there is a useful discussion on instrumentsand operating tables. Mention is made of a case in a

private house where four boxes and a small chest of drawershad been provided to serve as an operating table for excisionof a part of the lower jaw in a heavy man.The work is well illustrated ; in this edition some of the

older illustrations have been replaced by new ones.

1’ravaux de Chirurgie Anatomo-Clinique : Toies Urinaires,Estomac. (Clinical and Pathological Observations onSurgical Cases: : Urinary System and Stomach.) ) ByHENRI HARTMANN, Professeur Agrege at the Faculty ofMedicine, Surgeon to the Hooital Lariboisière, Memberof the Society de Chirurgie, Paris. With 113 figures inthe text. Paris: Georges Steinheil. 1903. Pp. xiii.-360. Price 15 francs.

THIS volume contains a number of articles emanating fromthe Lariboisière Hospital of Paris and dealing chiefly withthe urinary system and the stomach. Some of the articles

are based on clinical observations and some are devoted tothe recital of the results of pathological investigations.M. Hartmann has taken the chief part in the preparationof the book but many others connected with the hospitalhave assisted.

! The first paper contains a description, with numerous’

illustrations, of the "service Civiale" at the L-Ariboisi6re

Hospital. It was opened in 1901 and treats diseases of the. urinary tract ; it contains an out-patient department and,

also wards and an operating theatre. It appears to be fitted, very completely for the work that has to be done there.

Other articles deal with Direct Cystoscopy in the’

Female, Tumours of the Fatty Capsule.of the Kidney,1 Indications, Methods, and Results of Internal Urethrotomy,t Perineal Prostatectomy, the Bacteriology of Cystitis, Intra-avesical Separation of the Urine from the Two Kidneys, the Surgical Treatment of Lesions of the Stomach other thant New Growths, the Pathological Anatomy of Cancer of thee Stomach, and Duodenostomy.,

The volume has in it much that is interesting and willi- well repay perusal by those who devote their attention to

these special branches of surgery.______________

LIBRARY TABLE.

t Annual Rfport of the Imperial Bacteriologist for the 1earg 1902-1903. Calcutta: Office of the Superintendent of Govern-d ment Printing, India. 1903. Pp. 23+12.-This report isd divided into three sections. The first deals with researchd work on the question of rinderpest. During the year’y experiments were continued and concluded for the present’n with a view to determine the best method of producingL serum possessed of the highest protective Balue andls in the shortest possible time. In addition to the prepara-

tion of different kinds of sera, including those forut rinderpest, anthrax, and hsemorrhagic septicaemia, togethert- with the routine work of the laboratory, the imperial

bacteriologist has utilised his spare time during the last

three or four years in the elucidation of certain problemsIt such as "Whether it could be determined what are the

e constituents of the fifth or sixth day rinderpest bile whichct conferred immunity " ; " Whether, if determined, they couldhe be so collected and separately utilised as to per se confer

immunity," and kindred questions. Section II. deals withks the Applications of the Result of Research and Section III.3 : with Administration. Under this latter heading it is stated:ss that the major part of the officers’ time was occupiedhe in preparing rinderpest and anthrax sera, while exhaustivehe investigations were carried on into the etiology of barbone,

662

a disease of buffaloes clinically known as hæmorrhagic septi-caemia, with a view to discover the best method of pre-paring a protective serum and other methods of conferringimmunity against this disease for buffaloes and cattle gene-rally. Test experiments were continued throughout the

year to determine the protective power of all sera preparedat the laboratory. With the report is issued a " Note on thedifferent degrees of susceptibility to rinderpest exhibited bythe various pure and mixed breeds of bovines and buffaloes,&c., submitted to serum testing, by the serum alone’ andthe ’simultaneous methods’ during the years 1899-1903."

"

The important question as to whether anti-rinderpest serumshould be used indiscriminately or only in outbreaks of thedisease is discussed. Dr. A. Lingard, the imperial bacterio-logist, is of opinion that the time has arrived when the

injection of serum should only be practised at, and around,the centres of outbreaks of rinderpest. He writes : " In thefuture let the aims of the authorities interested be to attackeach centre of rinderpest as it is reported and endeavour todraw a cordon of protected cattle around each infectedarea." He considers that if this mode of procedure werefollowed the majority of outbreaks couldjbe stamped outwith a minimum mortality and the least possible expenditureof serum.

The Annual Report of the Pasteur Institute of India,Kasauli. August, 1902, to August, 1903. By Lieutenant-Colonel D. SEMPLE, R.A.M.C., Director of the Institute.

. Pp. 23.-During the year under review 584 patients under-went antirabic treatment, of whom 269 were Europeans and315 were natives. For statistical purposes these are dividedinto three classes: (a) those bitten by animals proved tohave had rabies; (b) those bitten by animals certified

by veterinary surgeons to have had rabies; and (c) those

bitten by animals suspected of rabies. Each of these

classes is again subdivided into (1) those bitten on the

head and face ; (2) those bitten through the exposedskin on any part other than the head or face; and

(3) those bitten through the clothing. The statistical table shows that amongst the 584 patients treated therewere six failures, which gives a percentage of 1’02. All the

failures recorded belonged to Class (c). In addition to the

six cases in which treatment failed four other patients(severely bitten) went too late to the institute and developedthe disease during treatment and two patients succumbedafter the completion of the treatment. These six cases cannotbe reckoned as failures because the nerve centres were

invaded by the virus of the animals which inflicted thebites before it was possible to render them immune againstthe disease. When the virus reaches the nerve centres

it is not possible to stave off the subsequent onset

by any known treatment. In a case of this kind hydro-phobia sets in with certainty within a period of 14 days ; nota single symptom need necessarily be present during the in-cubation period which follows the invasion of the nervecentres by the virus ; the only index as to when invasiontook place is the time when symptoms first set in. Thesestatements are based on the information derived from experi-mental rabies in animals. Lieutenant-Colonel Semple pointsout that the only trustworthy test of a rabid brain or cordconsists in inoculating an animal and waiting for the result(which generally takes 14 days) and that for diagnosticpurposes it is only necessary to send a small portion ofthe brain, the spinal cord, or the medulla in a small

bottle of sterile neutral glycerine. An antirabic serumhas been prepared with a view to improve the treatment

in badly bitten and late cases, by diminishing the timerequired to produce immunity. The serum is derived from

young healthy ponies which have been highly immunisedwith the virus of rabies. The experiments with this strongserum gave most satisfactory results and seeing that it has theproperty of destroying the virus of rabies in a mixture it is

. reasonable to suppose that it might be valuable as a first- dressing to apply to the wounds and for inoculation into

the tissues around the seat of a bite ; these points are under- investigation. When given hypodermically to animals it

; has no effect in warding off rabies when the virus has been

L inoculated subdurally. In badly bitten and late cases theobject is to confer a high degree of immunity as soon aspossible. By this treatment the benefits are given of a

. passive immunity conveyed by using the serum of anotheranimal which has been highly immunised, while the patient

’ is trained to acquire the more durable active immunitywhich can only be attained by undergoing a series of inocula-tions with the virus of rabies. The principle involved inthe preparation of anthrax vaccine is to obtain cultivationsof anthrax bacilli attenuated to such an extent as not

to convey the disease to the animals for which their, use is intended but at the same time strong enough

to confer an active immunity against an attack of, anthrax. 560 doses of this vaccine have been sent

out to applicants where outbreaks of anthrax had taken

place, but particulars as to the results have not yet beencollected. The information goes to show that none of theanimals inoculated contracted anthrax. The anti-venomousserum is now being sent out for use throughout India.The horses used in its preparation have been immunisedwith cobra venom; others are now being immunised withviper venom and mixed venoms. Following up the line ofLieutenant-Colonel Semple’s reasoning it is evident that

children and people of feeble physique require large dosesof antivenene to save them. In a case of cobra bite, whenthe patient is seen early and before symptoms have set in,the antivenene may be injected hypodermically in theloins. It is possible to save a patient at a much later

stage by giving the antivenene intravenously. A consider-able amount of ordinary bacteriological work has been

carried out at the institute during the year. The report iswell worthy of close study.

Cookery for Invalids and the Convalescent. Compiled byC. HERMAN SENN, G.C.A. Third edition. Revised and

enlarged. London : The Food and Cookery PublishingAgency. Pp. 101. Price 1s.-This little book contains some

good recipes for the preparation of food for invalids and forconvalescents. Much of the teaching which it contains is

quite sound-for example, the advantages of grilling are

duly set forth on p. 36. The directions given for the

preparation of beef-tea will be found generally useful.

Exception must be taken to cheese as a suitable diet forthe gouty. In the matter of jellies more information is

desirable. The reader is told to take some jelly " but nothow to make it. The work does not profess to be morethan a compilation and must be judged as such.

New Inventions.IMPROVED LIGATURE.

I DESIRE to bring before the notice of surgeons a

ligature which has for some considerable time givenme great satisfaction. It is made by a special process,from numerous single cocoon fibres, which produces a

ligature equal in every respect to silk twist and one

which has the following advantages. 1. Greater strengththan other ligatures have. 2. Simplicity and ease of

sterilisation ; a few minutes’ boiling renders it perfectlyaseptic. 3. Good keeping properties; it will keep in-

definitely unimpaired in the wet or dry state. 4. Absenceof any tendency to slip ; when tied on a vessel or a pedicleowing to the flat form the ligature assumes it has no

tendency to slip off. 5. Ready temporary encapsulisation