163

31r. Bellamy Gardner, and other authorities. The effect

produced by "mixed drinks" at a banquet could not o

be regarded in any way as analogous. Ethyl chloride w

formerly always existed to the extent of a small percent- S(

age in well-known brands of chloroform and of late yearswas being added in order to hasten the induction of c’anaesthesia. It was therefore absurd to suppose that the a

effect produced by the drug in sffj1wnce could materially a

differ from the effect when in rniaet1lre. The influence of the ilvarious operations was dealt with in detail and as regards age pyoung people from 12 to 15 years old were found to suffermost frequently from after-sickness, the rate of frequencysteadily diminishing from the fifteenth to the eightieth year. u

Females were more often troubled with sickness than males pin the proportion of five to four. As regards treatment little twas to be done. Drug treatment was merely palliative, the ..

measures advocated in text-books being practically useless. 1

Drinks of warm or hot or effervescing waters were of service, fas was albumin water. In bad cases washing out the stomach 1was of great use. Deprivation of fluids after operations was coften a mistake and overdone. Patients had a natural 1thirst after purging and loss of blood which should to some textent be gratified. The rational line of treatment lay instimulating the skin, kidneys, and bowels to throw what-ever anaesthetic was used out of the body tissues as soon asthis could be effected. 1

(

Reviews and Notices of Books.Handbveh der Geb11’!’tshÜlfe. (Handbook of Mid7vifery.) t

Edited by F. VON WINCKEL. In three vols. Vol. I., 1Second Part. With numerous plates and illustrations. tWiesbaden : J. F. Bergmann. Glasgow : F. Bauermeister. ‘1904. Pp. 643. Price 13s. 9d.

‘

A NOTICE of the first volume of this handbook appeared in (

THE LANCET of Feb. 27th, 1904, p. 583, and, as we pointed (out at the time, the fact that it is edited by Professor von jWinckel is a proof that it is a work of the very highest 1importance and value. The second volume more than

sustains the high opinion that we formed of the first andcontains a great deal of information of the utmost value. It

is devoted to a consideration of the physiology and dieteticsof pregnancy and the physiology and dietetics of labour.The word "diatetik" " in German means rather more thanwe are accustomed to assign to it in English, for under thedietetics of pregnancy are included the treatment of the

minor disorders of that condition and the preparation of thepatient for labour. The dietetics of labour, too, include theavoidance of rupture of the perineum and the treatment ofthe umbilical cord after the delivery of the child.The first chapter by F. Skutsch is concerned with the

Examination of the Pregnant Patient. It contains a verygood account of the various methods of external and

internal examination, the diagnosis of pregnancy from otherconditions simulating it, the important points in the dia-gnosis of a first and of subsequent pregnancies, and thedetermination of the period of pregnancy and of the size ofthe child.

P. Strassmann has written the second chapter on MultiplePregnancies and discusses not only their mode of develop-ment but also many questions connected with the variouspathological states which may be associated with, or

may be dependent upon, the presence of such a condition.The interesting question of the relationship of the occurrenceof multiple births to the general fertility of women isconsidered as also are the effect of heredity, and the

relationship between the frequency of twin pregnanciesand that of tripleeor quadruplet. The author calls attentionto various facts which suggest that tendency to multiplebirths shows an atavistic attribute in the human race, citingamongst other things the disproportionately frequentassociation with it of polymastia and its more frequentoccurrence in, animals low in the scale of development.

The section dealing with the Treatment of the Minor Dis-)rders of Pregnancy is contributed by von Herff ; and E. Bummwrites on the Preparation of the Patient for Labour. In thesecond portion of the book 0. Schaeffer describes the nervecentres of the uterus, the expulsive forces, the resistances,and the course of labour. The description of the bony pelvisand the soft parts is by H. Sellheim and is full and very wellillustrated. At the end of the chapter on the Attitude,Presentation, and Position of the Foetus Seitz concludes thatits attitude and position are primarily due to the form of theuterus and its activity ; whilst the frequency of vertex

presentations depends chiefly on the relationship betweenthe shape of the uterus and that of the child, the directionin which the uterine forces act, the great mobility of thefoetal head, and the preponderance in size of the upperuterine segment over the lower segment. Eighty pages aredevoted to the section on the Mechanism of Labour written

by M. Stumpf and he gives a very voluminous literature ofthe subject.

0. Sarwey writes Chapter VIII. dealing with the Diagnosisand Conduct of Labour and also treats of the prevention oftears of the perineum and the ligature and treatment of thecord after the delivery of the child. In discussing thequestion as to whether the antiseptic or aseptic managementof labcur is the better K. Menge declares in favour of

asepsis. He holds that the untouched genital canal is

aseptic and requires no disinfection and that the antiseptictreatment of labour is under all conditions objectionable.He believes it will only be by the strict avoidance of infec-tion of the hands, by abstinence from midwifery practicewhen the hands have been infected, and by the immediatestopping of any such practice in cases where any patientdevelops signs of septic infection, combined with rationaldisinfection of the hands and the use of sterile coveringsfor them, the avoidance of any unnecessary interference withthe patient, and the careful sterilisation of all the materialsused, that the danger of infecting lying-in women withpuerperal fever will be avoided.A very interesting contribution is that of G. Klein on

Walcher’s position. He gives a historical sketch of the

subject and discusses fully the advantages to be obtainedfrom its use in cases of difficult delivery. There is no partof the management of labour in which so many mistakesare likely to be made as in that of the third stage. The

tendency is to express the placenta too soon after the birthof the child and this practice frequently leads to theretention of some portion of the placenta or membranes.A. Lindfors gives a very interesting account of the fourchief methods of treating this stage and sums up in favourof the so-called Dublin method. The last chapter in thebook is by P. Strassmann and in it he considers the progressand course of labour in multiple pregnancies including thevarious abnormalities which may be met with.As we have said, the present volume fully comes up to

the high standard of the first. The book is the most

important work which has appeared for some years on thesubject of midwifery and when completed will form a hand-book of the greatest possible value and one that will beindispensable for every teacher of this branch of medicine.

Exercises in Practical Physiology. By AUGUSTUS D.WALLER, M.D. Aberd., F.R.S. Part II., Exercises andDemonstrations in Chemical and Physical Physiology.By A. D. WALLER and W. LEGGE SYMES. London :Longmans, Green, and Co. 1905. Pp. 79. Price2s. 6d. net.THESE exercises consist of eight chapters dealing suc-

cessively with the blood, circulation, carbohydrates and

salivary digestion, proteids and gastric digestion, fat and

pancreatic digestion, milk (bile and muscle), urine, and

respiration. This little work forms a companion to the

164

author’s systematic work, to which reference is made an

from which some of the illustrations are reproduced. 0

the whole the experimental part seems to us to t

fuller than the more purely chemical sections. All tl

directions are precisely given and can be easily followed bthe student in the laboratory. Students who have to preserthemselves for a practical examination involving the subjecidiscussed will find this book useful and so also will studentin a properly equipped laboratory. Naturally, a fair numbfof the experiments must be in the nature of demonstrationbv the teachers rather than the actual work of the studeuof physiology. In these cases this is stated and full detailare given.

.LVet7iods of -3-rog-bid Histology and Clinical PathoZoqy. B1. WALKER HALL, M. D. Vict. (Manchester). and G1. WALKER HALL, M D. Vict. (Manchester), and GHERSHEMER (Wiesbaden). London and EdinburghW. Green and Sons. 1905. Pp. 290.

A BOOK of this type, designed for the requirements ostudents and pathologists working in hospitals and insti

tntes, makes no claim to originality. Indeed, it consist

largely of recipe methods taken from well-known text

books, while the authors state in particular their indebtedness to the work of Schmorl-i.e., " Die Pathologisch-Histologischen Untersuchungsmethoden." Of this work, the secon(edition (1901) is before us. The authors state that thl

details of methods they record were, except in a few casesobtained from the original papers and a list of papers i:

appended. As one of the authors was assistant to the latlCarl Weigert for several years it is appropriate that theibook is dedicated to his memory.There is nothing new in the chapters devoted to the ex

amination of fresh objects, freezing, fixation, hardening, ancdecalcification ; nor, indeed, is there in those on imbeddingsectioning, clearing, mounting, or staining. Substantiall3the same methods are applicable to normal animal histologyand are to be found in text-books on that subject. In thE

chapter on special cell and tissue structures the method:are in some respects like those adopted in Schmorl’s wor)3in the chapter dealing with methods for demonstrating specialconstituents of cells and tissues.

In Chapter XII. special tissues and organs are dealt withand that on the nervous system is naturally crowded ; infact, there are too many methods bearing the names of theiiauthors-modifications of some fundamental method. Itwould have been better had the authors been able to give theaspiring tyro some definite statements as to the comparativevirtues of these modifications.The methods regarding bacteria, moulds, and other fungi,

and animal parasites occupy more than 30 pages, while toclinical microscopy eight pages are given. It will be seen

that the word "clinical pathology" is taken in a somewhatrestricted sense ; and only those methods which a pathologistmay require during his routine work are given.The book will be found useful for reference but the

student may have difficulty in knowing which of thenumerous methods he ought to select.

Hea7th and Disease in Relation to Marriage and the MarriedState. Edited by Geheimer Medizinalrat ProfessorDr. H. SENATOR and Dr. Med. S. KAMINER. The onlyauthorised translation from the German into the Englishlanguage by J. DULBERG, M.D. Wiirzburg, of Man-chester. London and New York: Rebman, Limited. Vol. II., pp. 777. 1905. Price, for two vols., 30s. net.

IN our issue of Oct. 8th of last year we reviewed the firstvolume of this work. The second volume is now before us;it is divided into 14 chapters which treat respectively of(XIV.) Gonorrhceal Diseases in Relation to Marriage ; (XV.)Syphilis in Relation to Marriage ; (XVI.) Diseases of theSkin in Relation to Marriage ; (XVII.) Diseases of the Organs

nd of Locomotion ; (XVIII.) Diseases of the Eyes, with specialOn regard to Heredity; (XIX.) Diseases of the Lower Uro-

be genital Organs and Physical Impotence ; (XX.) Diseaseshe of Women, including Sterility; (XXI.) Diseases of the

by Nervous System ; (XXII.) Insanity in Relation to Marriage;Ttt (XXIII.) Perverse Sexual Sensations and Psychical Impo.ts tence ; (XXIV.) Alcoholism and Morphinism in Relation toits Marriage ; (XXV.) Occupational Injuries in Relation

to Marriage ; (XXVI.) Medico-Professional Secrecy in Rela.ns tion to Marriage ; and (XXVII.) the Economic Importancent of Sanitary Conditions.ils The section on gonorrhoeal diseases is from the pen

of Professor A. Neisser of Breslau. It is, we think, themost important in this volume and is well worthy of study.

3y Professor Neisser points out that there is hardly anotherdisease dealt with-not even syphilis-that has such far.

reaching and momentous consequences for the marriedstate as gonorrhoea. The dangers to the female emanating

of from chronic gonorrhoea in the male are brought as

,i- prominently forward as they deserve to b9. The teaching ists that when marriage is contemplated, as all post-gonorrhœict- residual affections are not infectious, it is necessary tod- subject every individual who presents any abnormal sym-

ptoms derived from a former gonorrhoea to a special exami.’cl nation for the purpose of ascertaining whether these sym-e ptoms are still of an infectious nature. The examinations, for gonococci alone enables the physician to say whetheris marriage should be permitted and this examination should be

made as searching as possible. In the case of men it is neces-ir sary to examine not only the superficial secretion of the

anterior urethra and that of the posterior urethra-if possibleseparately-but to endeavour to bring to light the secretionsituated in the crypts between the folds of the urethralmucous membrane and to examine it. Careful search must

y be made for the existence of preputial and para-urethral’y passages, of ilstulas and small abscess-cavities. In specialIe cases it may be necessary with the help of the endoscope toIs look also for gland-like epithelial swellings lying in thek urethra. Professor Neisser examines every case of chronic

urethritis by means of Gram’s method, and when the ques-tion of marriage is under consideration he makes use of the

h cultivation-method also.The chapter on Medico-Professional Secrecy is writtenlr from the point of view of a German medical practitionera and is, therefore, not applicable to English and Americane conditions, but it is interesting reading. The diversitye of medical practice very often places medical men in

the unpleasant situation of having to choose between theinjunctions imposed upon them by the different laws and

o the dictates of their own consciences. In Germany the lawn admits of no exceptions and a medical man has no right tot divulge what has become known to him in his professionalt capacity, no matter how serious the consequences may

eventually turn out to be.e Dr. Dulberg is to be congratulated on having completede his task and on having given us a translation of the

most comprehensive work on a subject which is of interestto every practitioner.

r Report of the Board of Agriculture and Fisheries for 1904.

’ London : Darling and Son. Price lld.

- THE report of the work done by this department of the. Government is one of the most hopeful which has been

issued for some years. Mr. Cope, M.R.C.V.S., the chief

veterinary officer, is able to congratulate the country on the; success which has prevailed in regard to certain cattle

E scourges, particularly foot and mouth disease and pleuro-) pneumonia, neither of which, we hope, will ever reappear ini Great Britain. Swine fever, too, is on the decrease,s although still far too widespread and met with in very

165

many counties. A report of the latest commission ir

appointed to inquire into the pathology, and so on, of the irdisease has been promised shortly. Anthrax is largely H

increasing and one factor in its spread is the habit, through tlignorance of the methods of propagation of the disease, Son the part of the average farmer of opening the carcass 8of a cow (which has died suddenly) to try to find out bthe cause. If instead of doing this he would report to the I-local veterinary authority fewer cases would occur as a I

sequel to the first death. Epizootic lymphangitis, which has been imported into t

England with the returned army horses from South Africa, a

has, on account of its tedious course when treated and itscontagiousness, caused the Government to issue a pamphletto every member of the veterinary profession in the BritishIsles. This pamphlet describes the differences between thisdisease and farcy. Glanders is admittedly on the increase andit is time that some radical measures were taken to control

this disease. In 1894 there were only 502 outbreaks reportedbut in 1904 these had increased to 1529 and 2658 horses

were killed as glandered. More power ought certainly tobe given to the veterinary inspectors to test the in-contacthorses with mallein, as by this agent an almost infallible diagnosis can be made within 24, or at most 48, hours. The

expense, although great the first year, would not be

excessive if allowed to be spread over a period of years;and where a preventable disease, which also causes the

deaths of numbers of human beings each year, is concerned,the cost ought certainly not to be considered too seriouslyas a reason why it should not be taken thoroughly in hand.Sheep scab is favourably reported upon and rabies is non-

existent. The latter is a cause for much congratulation andit is to be hoped that the present successful measures will becontinued. Many other diseases are touched upon and thebook is well worth a place in the library of everyone who isinterested in the subject of the diseases of animals.

JOURNALS AND MAGAZINES.

The Journal of Physiology. Edited by Sir MICHAEL

FOSTER, K.C.B., F.R.S., and J. N. LANGLEY, F.R.S.Vol. XXXII., Nos. 3 and 4. May, 1905. London: CambridgeUniversity Press Warehouse. Pp. 127. Price 8s.-This partcontains the following articles: 1. The Fractional Hydrolysisof Optically Inactive Esters by Lipase, Part II., by H. D.Dakin. 2. Observations upon Fibrin Ferments in the Venomsof Snakes and the Time Relations of their Actions, byC. J. Martin. 3. On the Formation of Fatty Acids fromLactic Acid when fused with Caustic Alkalies, by H. S.Raper, 1851 Exhibition Scholar. 4. Note on Neumann’sMethod of estimating Chloride, by W. Legge Symes.5. The Regulation of the Lung Ventilation, by J. S. Haldaneand J. G. Priestley, with 11 figures in the text. Theauthors show that at a constant atmospheric pressure theair in the alveoli of the lungs contains a practicallyconstant percentage of carbon dioxide but in differentindividuals this percentage differs. Within limits with

varying atmospheric pressure the alveolar percentage variesin each individual inversely as the atmospheric pressure, sothat the alveolar carbon dioxide pressure is constant whilethe oxygen pressure varies widely. The respiratory centre isexquisitely sensitive to any rise in the alveolar carbondioxide pressure, a rise of 0. 2 per cent. of an atmospherebeing sufficient to double the amount of alveolar venti-lation. When the oxygen pressure in the inspired air fallsbelow about 13 per cent. of an atmosphere the respira-tory centre begins to be excited by want of oxygen.During muscular work the alveolar carbon dioxide

pressure is raised slightly with a corresponding largeincrease in the lung ventilation. The amount of air

breathed per minute and per unit of body varies widely

1 the same individual and still more widely in differentldividuals. 6. The Separation of Proteids, by H. C.

taslam, formerly John Lucas Walker student. 7. Onhe Products of Digestion of the Proteolytic Enzyme of theipleen acting in an Alkaline Medium, by E. P. Cathcart.:, The Effect of Cold Narcosis on Reflex Action in Warm-blooded Animals, by Sutherland Simpson and Percy T.

lerring. 9. The Effects of Acids upon Blood, by Charles E.Jam and Hermann Balean. 10. Observations on the Munchi.rrow Poison, by Alfred Frohlich. The Proceedings ofthe Physiological Society for Feb. 25th and March 18thare also contained in this part.

Reports and Analytical RecordsFROM

THE LANCET LABORATORY.

EUDRENINE.

(PARKE, DAVIS, AND CO., 111, QUEEN VICTORIA-STREET, LONDON, E.C.)EUDRENINE is described as a local anaesthetic and haemo-

static for the painless and bloodless extraction of teeth andfor use in general surgery. It contains in each cubic centi-metre 0.01 gramme of the anaesthetic beta-eucaine hydro-chloride and 0 - 033 milligramme of the powerful haemostaticadrenalin chloride (Takamine). For tooth extractioneudrenine is used undiluted by injecting into the gumten minutes before operating the contents of one or two

"ampoules," equal to eight or 17 minims, according to thenumber of teeth to be extracted. For small surgical opera-tions eudrenine is used undiluted but when a large area isrequired to be anaesthetised it is diluted with four volumesof "physiological" sodium chloride solution. The advantagesof beta-eucaine over cocaine are well known and the objectof combining it with adrenalin is to contract the blood-vessels so that not only is the action of the anaestheticlocalised but the operation may be performed without

bleeding. The result is that only a small quantity of theanaesthetic is required.

(1) SUGARLESS JAM; AND (2) STARCHLESS BISCUITS.(CALLARD AND Co., 74, REGENT-STREET, LONDON, W.)

According to our examination both of these preparationsmay be given to patients in whose cases sugar is pro-hibited. In the jam we found a trace of sugar which,according to the phenyl-hydrazine test, appeared to be milksugar, since the small quantity of crystals producedhad the characteristic appearance of lactosazone. Therewas also a slight reduction with Fehling solution. The jamis sweet to the taste owing to glycerine and has the con-sistence of ordinary jam. The flavour of the sample sub-mitted to us was that of black currant. The colouring israther brilliant but of a harmless kind. The biscuits gaveabsolutely negative evidence as regards the presence of

starch, the chief constituent being proteid which to someextent is soluble in water. Reactions were obtained withthe solution characteristic of milk proteid.

PURE GRAPE PORT.

(HUNT, ROOPE, TEAGE, AND CO., OPORTO, AND 3 AND 4, WATER-LANE,GREAT TOWER-STREET, LONDON, E.C.)

. This is an undoubtedly genuine _port wine and as the; following analysis shows is of a robust and an invigorating. character. It is more suitable for invalid purposes than as. an after-dinner wine. The analysis was as follows : ex-

tractives, 14’ 30 per cent. ; mineral matter, O. 25 per cent. ;sugar, 12’50 per cent.; volatile acidity reckoned as acetic

r acid, 0’066 per cent.; fixed acidity reckoned as tartaric acid, 0.21 per cent.; and alcohol, by weight 19-58 per cent.,