648 pages, with 176 illustrations and 5 full-page plates. (Cloth, $3.75, net. Lea & Febiger, Philadelphia and New York, 1908.

High-Frequency Currents by Frederick Finch Strong, M.D. Instructor in Electro-therapeutics at Tuft's College Medical School, Boston. With 183 illustrations in the text. Rebman Company, 1123 Broadway, New York.

Textbook of Nervous Diseases and Psychiatry for the use of students and practitioners of medicine, by Charles L. Dana, A.M., M.D., LL.D., professor of nervous diseases in Cornell University; neurologist to the Montefiore Hospital; neurologist to the Woman's Hospital, etc. Seventh edition. Two hundred and sixty-one engravings; three plates in black and colors, pp. 782. New York: William Wood & Company. 1908. (Price, cloth $5.00 net.)

Operative Midwifery, by J. M. Munro Kerr, M.B., C. M. Glas. Fellow of the faculty of physicians and surgeons, Glasgow; obstetric physician to Glasgow Maternity Hospital; gynecologist to the Western Infirmary, etc., with 294 illustrations in the text. New York: William Wood & Company. 1908. (Price, $6.50 net. Cloth.)

Textbook of Operative Surgery, covering the surgical anatomy and operative technic involved in the operations of general surgery designed for practitioners and students, by Warren Stone Bickham, M.D., Phar.M., junior surgeon to Touro Hospital, New Orleans etc. Third edition, greatly enlarged. 854 illustrations, pp. 1206. W. B. Saunders Company, Philadelphia and London. 1908. (Price, cloth $6.50 net.)

Manual of Clinical Diagnosis by James Campbell Todd, Ph.B., M.D., associate professor of pathology Denver and Gross College of Medicine, University of Denver, etc. Illustrated. W. B. Saunders Company, Philadelphia and London. 1908. (Price, $2.00 net.)

The Campaign against Tuberculosis in the United States, including directory of institutions dealing with tuberculosis in the United States and Canada. Compiled under the direction of the National Association for the Study and Prevention of Tuberculosis by Philip P. Jacobs, New York: Charities Publication Committee 1908. (Price, $1.00 net.)

On the Means of the Prolongation of Life, by Sir Hermann Weber, M.D., F.R., C.P. Consulting physician to the German Hospital, the National Hospital for consumption, Ventnor, the Mount Vernon Hospital for consumption and a member of the consulting committee of King Edward VII sanatorium at Midhurst, London. John Bale, Sons, and Danielsson, L't'd., Oxford House 83-91 Great Titchield street, Oxford street, West. 1908. (Price, $1.25 net.)

Spectacles and eyeglasses, their forms, mounting, and proper adjustment, by R. J. Phillips, M.D., ophthalmologist to Presbyterian Orphanage, etc. Fourth edition, revised, with 56 illustrations. Philadelphia: P. Blakiston's Son & Company, 1012 Walnut street. 1908. (Price, $1.00 net.)

Transactions of the Thirtieth Annual Meeting. of the American Laryngological Association held at Montreal, Canada, May 11, 12, 13, 1908. New York: Published by the association. The McConnell Printing Company, printers. 1908.

Intestinal Autointoxication, by A. Combe, M.D., professor of clinical pediatry at the University of Lausanne (Switzerland), together with an appendix on the lactic ferments with particular refer

ence to their application to intestinal therapeutics, by Albert Fournier, formerly demonstrator at la Sorbonne, Paris. Only authorised English adaptation by William Gaynor States, M.D., clinical assistant in rectal and intestinal diseases at the New York Polyclinic. Eighteen figures, four colored. Rebman Company, New York. 1908. (Price, cloth $4.00.)

Refraction of the Eye, by Harry C. Parker, M.D., Clinical Professor of Ophthalmology, Indiana University School of Medicine, Indianapolis. With 106 illustrations. Philadelphia and London: W. B. Saunders Company. 1908. (Price, $1.25 net.)

Reference Handbook for Nurses by Amanda K. Beck, Graduate of the Illinois Training School for Nurses. Second edition. Revised. Philadelphia and London. W. B. Saunders Company. 1908. (Price, $1.25 net.)

Obstetric and Gynecologic Nursing by Edward P. Davis, A.M., M.D, Professor of Obstetrics in the Jefferson Medical College, Philadelphia; Obstetrician and Gynecologist to the Philadelphia Hospital; Consultant to the Preston Retreat. Third edition, thoroughly revised. Philadelphia and London: W. B. Saunders Company. 1908. (Price, $1.75 net.)

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.) Textbook of General Bacteriology. By Edwin O. Jordan, Ph.D. Professor of Bacteriology in the University of Chicago and in Rush Medical College. Fully illustrated. Philadelphia and London: W. B. Saunders Company. 1908. (Price, $3.00 net.)

Textbook of Diseases of Women. By Charles B. Penrose, M.D., Ph.D., formerly Professor of Gynecology in the University of Pennsylvania; Surgeon to the Gynecean Hospital, Philadelphia. With 225 illustrations. Sixth edition revised. Philadelphia and London: W. B. Saunders Company. 1908. (Price, cloth $3.75; half-morocco, $5.25 net.)

"Doctor:" said the shrewd-looking man, "how many feet of gas does it take to kill a man?"

"That's rather a queer question," replied the doctor. "Why do you wish to know?"

"Well, you see, one of the guests at my hotel used enough of it to kill himself, and I want to send in a proper bill to his executors."-Philadelphia Press.

"Here is a doctor who says you mustn't eat when you're worried."

"But suppose you're always worried for fear you ain't going to get anything to eat?"-Cleveland Plain Dealer.

Lobster and champagne for supper-that's high jinks. Sawdust and near-coffee for breakfast-that's hygiene. Between these two eminences, however, there's room for some genuine living-Life.

T1

Report of Cases1

By HERMAN E. HAYD, M. D., Buffalo, N. Y.

HE importance of this subject, together with its very frequent occurrence and the now universally accepted surgical treatment of the condition, has prompted me to write this paper, in which I shall try to deal, briefly and practically, with a few phases of the question and giving in its course, the conclusions which have been forced upon me as a result of an experience with seventy-three cases, in all stages of development, and perhaps with all possible complications and difficulties. After studying my records, they may be conveniently grouped into certain distinct and separate classes.

First. Those in which rupture had not taken place.

Second.-Those in which sudden rupture occurred and a large vessel was opened, or a tubal abortion in which the bleeding continued freely into the peritoneal cavity, and where there was no tendency to localisation of the hemorrhage or the formation of an hematocele,-the so-called tragic or cataclysmic cases.

Third.-Cases in which rupture, partial or complete, had taken place, including tubal abortion, partial and complete,and where upon operation a large pelvic hematocele, more or less completely encysted, existed and where the ovum was so small that it either escaped observation or it was broken down in the blood clots which were in the sac contents. In this group can also be included those cases where the rupture took place on the under surface of the tube and the blood escaped into the folds of the broad ligament, producing a broad ligament hematocele, which, in my experience, is a rare variety and cannot often be diagnosticated until the abdomen is opened.

Fourth. A group where rupture took place, but where the ovum continued to grow, say up to the fourth or fifth month, either within the peritoneal cavity or between the folds of the broad ligament, because it was not completely detached at the time of rupture, or because it made a new placental attachment.

1. Read at the Buffalo Academy of Medicine, October 27, 1808.

Fifth. A class where the conception product broke down more or less completely and formed a pelvic abscess, or where its contents, pus, bones and debris, were being discharged either through the vagina, rectum, bladder or abdominal wall.

Sixth. Where the fetus went on developing until it was viable or to term, and was then delivered by operation, or it died during labor and was finally removed as a lithopedion or other degenerated product.

Any form of pregnancy outside of the uterus is termed extrauterine, and so far as we are interested, clinically anatomical distinctions are of little value; because it matters not whether the condition be one of tubal abortion or rupture in any part of the tube or cornu, the symptoms are practically the same and their relief must usually be brought about by surgical intervention.

The diagnosis of ectopic pregnancy before rupture takes place is seldom made because the cases do not come under observation early enough, and usually when a specimen is obtained early in the period of fecundation, it is because an operation was undertaken for some other condition, or where a tentative diagnosis was made with merely a suspicion of tubal pregnancy, because a slightly distended tube, whether by serum, blood or pus or an aberrant ovum, may give the same objective and subjective symptomatology. However, any tense, elastic and painful swelling of the tube, particularly when the swelling is confined to one side, and with a uterus reasonably movable, should always make the surgeon suspicious, especially if the period has been delayed, or if there has been present some irregular bleeding from the uterus. Pus in a tube, especially if slow in development, is usually associated with considerable exudate, and therefore more adhesions exist than are generally present with an early extrauterine pregnancy. Hydrosalpinx, in my experience. is comparatively rare, and hematoceles of the tube are most often the result of a slightly or completely detached extrauterine ovum, hence we are justified in making this general statement that any tense, elastic and painful swelling of the tube may be, and often is, an early extrauterine fetation, and should be most carefully watched, as an operation may become necessary at any moment.

In the examination of these women much care must be exercised, as the sac often ruptures as a result of the manipulations. This accident occurred to me once in one of my patients, whom I was examining in my office. She came, complaining of severe pain in the left side which made walking painful. During the examination I felt a painful, tense tumor in the left ovarian

region, and while performing bimanual palpation, she was suddenly seized with an acute cramp-like pain; was nauseated and became faint. I removed her at once to the German Hospital, and opened her abdomen, which contained a large amount of free red fluid blood. The left tube had a rough, irregular tear in it near the fimbriated end, from which blood was flowing very freely. The ovum had escaped into the peritoneal cavity. The patient made a very rapid and excellent recovery.

A second patient,-which may be placed in either the first or second groups,-I saw in consultation with Dr. Gibson, to whom I referred the case, and as the history is exceedingly interesting though a very common one, I shall give it briefly:

MRS. W., aged twenty-five, married two and one-half years. A fine, healthy English woman, who had always been well and regular, but at the last period she flowed rather profusely. She sent for a neighboring young doctor who thought she had a miscarriage, and proceeded at once to curet her, which he did without an anesthetic. Two days after this so-called curetment I saw her, and upon vaginal examination, discovered a small globular swelling in the left side, tense and painful. The uterus was tender, and pain was elicited upon gentle manipulation. I enjoined rest; applied poultices, and gave a little codeia to relieve the pain. She had a temperature of 100°. Upon the following day I saw her again, and turned the case over to Dr. Gibson, directing him to pay particular attention to a possible extrauterine fetation. As there was still some temperature, I felt that a few days should be taken to eliminate the swollen tube as a result of an infection with the traumatism consequent upon the curetage. Dr. Gibson reported that the patient was doing well, and that the husband had requested him to discontinue his visits, as he thought them unnecessary.

Four weeks after my first visit I was again called to the patient's house, as she was suffering great pain and had been in much distress for some days previous. Upon examination it was at once plainly evident that she was suffering from a large encysted hematocele, the result of a ruptured tubal pregnancy. I removed her to the German Hospital, and under chloroform, opened the culdesac and let out over a pint of black blood and blood clots of various sizes. The cavity was thoroughly irrigated with salt solution, and a piece of gauze was lightly packed into the vaginal cut for drainage. She did well for one week, the temperature remaining normal and then she began to complain of a good deal of pain, there being a constant elevation of temperature of a couple of degrees. On January 12, I opened her abdomen, and removed a large stinking mass, which was a ruptured tube with more or less organised broken-down blood clot. A guaze drain was placed low in the pelvis. She reacted nicely and did well, and on the thirteenth day, with normal