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Tuberculous

of the

In tuberculous patients presenting cavities Surgical Treatment of sufficient size to render an accurate diag

nosis possible, major operative procedures Cavities Lung

are rarely indicated owing to the low state

of their general health. In isolated cases, however, where the cavity communicates by a fistulous passage with the external thoracic wall, it may be advisable to resort to surgical intervention, which has sometimes proved very beneficial. Dr. Bessel-Hagen has reported such a case to the Surgical Union of Berlin. The patient, who had previously suffered with cough, developed a small abscess over the upper part of the sternum, with a slight infiltration over the right clavicle. The abscess was opened by a T incision, and it was found that fistulous passages extended toward the right into the pectoralis major and toward the left around the sternum into the deeper parts.

After they had been laid open, the upper part of the sternum with the sternal attachment of the ribs was removed, preserving the sternoclavicular joint. Behind the removed bone a larger abscess cavity was exposed, with fistulous passages, which ran upward into the area of infiltration above the clavicle, backward to the vertebral column, and toward the right, below the first rib, into the lung substance. All the tuberculous tissue as far back as the vertebral column, as well as two tuberculous mediastinal glands, were removed. To follow the course of the fistula extending into the right lung a larger piece of the first rib had to be excised and the internal mammary artery ligated. The soft parts covering the fistulous passage were divided until access was gained to a large pulmonary cavity. This was found to contain a thin purulent fluid. The walls were quite smooth, containing only a few caseous foci, which were carefully removed with the sharp curette. The operation had to be constantly interrupted on account of the frequent paroxysms of cough. The cavity was tamponed with iodoform gauze. Recovery was uneventful, and the later course of the case has been favorable, with marked improvement of the nutrition, and disappearance of all pathological appearances in the lung.-International Journal of Surgery.

A MEDIASTINAL tumor may be present for some time without other symptoms than cough, expectoration, loss of flesh and slight fever-thus simulating pulmonary tuberculosis. A skiagraph will determine the condition ; laryngoscony is also helpful, for adductor paralysis is frequentlv an early sign.-American Journal of Surgery.

Proceedings of Societies.

ONTARIO MEDICAL ASSOCIATION.

The next annual meeting of the Ontario Medical Association will be held in Toronto on June 1st, 2nd and 3rd, 1909. The following officers were elected last year to look after the interests of the Association at the coming meeting: President-Dr. H. J. Hamilton, Toronto. Vice-Presidents-Dr. R. R. Wallace, Hamilton; Dr. A. Dalton Smith, Mitchell; Dr. A. M. McFaul, Collingwood; Dr. Geo. Field, Cobourg. General Secretary-Dr. E. Stanley Ryerson, 243 College St., Toronto. Assistant Secretaries --Dr. Samuel Johnston, 169 Carlton St., Toronto; Dr. J. E. Davey, 145 King St. West, Hamilton. Treasurer-Dr. J. Heur,

. ner Mullin, 201 James St. South, Hamilton. Chairman Committee on Papers and Business-Dr. Herbert A. Bruce, 64 Bloor St. East, Toronto. Chairman Committee on ArrangementsDr. Bruce L. Riordan, 73 Simcoe St., Toronto.

The Committee again decided to adopt the system of dividing up into sections, of which the following is a list, with their officers:

Surgery—President, Dr. G. A. Bingham; Secretary, Dr. A. B. Wright.

Medicine—President, Dr. W. H. B. Aikins; Secretary, Dr. F. A. Clarkson.

Obstetrics and Diseases of Children--President, Dr. Adam Wright; Secretary, Dr. J. A. Kinnear.

Eve, Ear, Throat and Nose-President, Dr. D. J. G. Wishart; Secretary, Dr. C. Campbell.

Preventive Medicine-President, Dr. C. Sheard; Secretary, Dr. C. J. Hodgetts.

General sessions will be held in the afternoons and on one evening, the Sections of Surgery and Medicine meeting every morning, and one of the Special Sections on each morning.

The Committee on Papers and Business have been successful in getting promises of papers from the following men: Dr. John B. Deaver, Philadelphia; Dr. E. F. Cushing, Cleveland, on “ Copious Water-Drinking in Typhoid Fever”; Dr. W. P. Manton, Detroit; Dr. Little, Montreal; Dr. C. H. Vrooman, Winnipeg; Dr. A. Baines, Toronto; Dr. McFaul, Collingwood;

Dr. Slemons, New York; Dr. McDonald, New York; Dr. J. M. Elder, Montreal; Dr. J. M. Rogers, Ingersoll; Dr. Hadley Williams, London; Dr. H. B. Anderson, Dr. W. McKeown, and Dr. C. B. Shuttleworth, Toronto; Dr. E. Ryan, Kingston.

In order to get in closer touch with the various City and County Medical Societies throughout the Province, a motion was passed making the Presidents of these Societies Corresponding Members of the Committee. As some difficulty has been encountered in securing their names, the Secretary will be much obliged if the gentlemen occupying this position will send him their names and addresses. They will be kept informed from time to time of the work done by the Committee.

Physician's Library.

l'accine Therapy and the Opsonic Method of Treatment. A

short compendium for general practitioners, students and others. By R. W. ALLEN, M.D., B.S. (Lond.), late Pathologist to the Royal Eye Hospital. Late Gull Student of Pathology, Guy's Hospital. Second edition. Price, 7s 6d, net. London: H. K. Lewis, 136 Gower St.

As we were not awarded the pleasure of reviewing the first edition of this timely book, we cannot tell particularly wherein there is any improvement over the first. No doubt the demand has been so great that a second edition has been essentially necessary. The first edition was issued in November, 1907. Since that time the evidence has been conclusive that vaccine therapy has come to stay. The profession will welcome this second edition.

A Text-Book of Diseases of Women. By Chas. B. PENROSE,

M.D., Ph.D., formerly Professor of Gynecology in the University of Pennsylvania. Sixth revised edition. Octavo of 550 pages, with 225 original illustrations. Philadelphia and London: W. B. Saunders Company. 1908. Cloth, $3.75 net; half morocco, $5.25 net. Canadian agent: J. A. Carveth & Co., Ltd., Toronto.

On five former occasions, it has been our pleasure to give notice to this admirable book. It speaks well for Penrose's “ Diseases of Women," when one knows this is the sixth revised edition. The increase in knowledge regarding gynecology has called for a revision. Originally written for the medical student as a textbook, demand for it on the part of the student who had entered upon and was practising medicine called for edition after edition, until to-day Penrose's book is one of the best known and widest used books on the subject of gynecology. It goes straigh: to the subject at the very start, embryology, anatomy, physiology, etc., having been eliminated.

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Diseases of the Skin and the Eruptive Fevers. By Jay FRANK

SCHAMBERG, M.D., Professor of Dermatology and Infectious
Eruptive Diseases in the Philadelphia Polyclinic and College
for Graduates in Medicine. Octavo of 534 pages, illustrated.
Philadelphia and London: W. B. Saunders Company. 1908.
Cloth, $3.00 net. Canadian agent: J. A. Carveth & Co.,
Limited, Toronto.

This is a book which will be very acceptable to general practitioners and medical students. It is nicely printed, beautifully and elaborately illustrated for a book of its size—534 pages; concise, practical; a model of a working handbook on these two subjects. It is right up to date: three chapters on Actinotherapy and Radiotherapy and one on radium. Those on syphiloderma, small-pox, and especially chicken-pox, are, we think, for a work of this size and scope exceptionally good. A striking feature of the book is the many original illustrations. Some of these particularly show “ before and after ” treatment, as in epithelioma, etc. It gives us pleasure to testify to the undoubted value of this book.

Obstetrics for Nurses. By JOSEPH B. DELEE, M.D., Professor

of Obstetrics in the Northwestern University Medical School, Chicago. Third revised edition. 12mo. of 512 pages, fully illustrated. Philadelphia and London: W. B. Saunders Company. 1908. Cloth, $2.50 net. Canadian agent: J. A. Carveth & Co., Toronto.

Here is a little work which, if we are not greatly mistaken, will prove a god-send not only to those qualifying for the nursing profession, but also to many medical men, and also to many women who are possessed of a laudable desire to have an up-to-date knowledge of the management of a normal labor. The text is

very clear, and the illustrations, excellent, as well as numerous, are nearly all reproductions of photographs of actual scenes.

To see this little book, is to desire it: then, you naturally buy it.

Gynecology and Abdominal Surgery. In two large octavos.

Edited by HOWARD A. KELLY, M.D., Professor of Gynecologic Surgery at Johns Hopkins University; and CHARLES P. NOBLE, M.D., Clinical Professor of Gynecology at the Woman's Medical College, Philadelphia. Large octavo volume of 862 pages, with 475 original illustrations by Mr. Hermann Becker and Mr. Max Brodel. Philadelphia and London: W. B. Saunders Company. 1908. Per volume: Cloth, $8.00 net; half morocco, $9.50 net. Canadian agent: J. A. Car

; veth & Co., Limited, Toronto.

In a former number of this journal we had the pleasure of reviewing the first volume of this great work, and it has afforded us no little satisfaction to peruse this volume. To attempt to give anything like a complete review of it, however, is about as feasible as describing the various exhibits at a World's Fair, in one page! The articles dealt with in this volume are: Complications following operations, Cesarean section, operations during pregnancy, the operative treatment of sepsis in the child-bearing period, extrauterine pregnancy, diseases of the female breast, operations upon the gall-bladder, bile ducts and liver, operations upon the stomach, pyloroplasty, intestinal surgery, operations for diseases of the vermiform appendix, surgery of the pancreas, operations upon the spleen, tuberculosis of the peritoneum, penetrating wounds of the abdomen, hernia, the use of drainage in abdominal and pelvic surgery, surgery of the ureter, and surgery of the kidney. Each subject is so exhaustively dealt with, both in the matter of history, differentiation, and details of operation, that it would seem like making an invidious distinction to single out any particular writer's article.

To sum up, therefore, in a general way, one may draw attention to the excellent, clear text, and the almost prodigal display of illustrations, by no means the least valuable details in the general excellence of this immense work. What is gospel today (in surgery) is out of date to-morrow, so rapid is the advancement in this branch of the healing art; but one feels tempted, nevertheless, to predict that for a goodly time to come, Kelly and Noble's “Gynecology and Abdominal Surgery” will undoubtedly prove a classic to a great many general practitioners as well as surgeons on this continent.

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