gister of deaths; Nurses' addresses; Addresses of patients and others; Cash account.

The prices of regular lists are: for 60 patients a week, with or without dates, handsomely selected red or black, morocco binding, $1.50; for 30 patients a week, with or without dates, same style, $1.25; also a few special 90 patient lists, $2.00.

These visiting lists are fitted into genuine seal and calf skin. wallets, making the most elegant books of the kind ever offered to the profession. The lists proper are in two books of six months each, and are removable from the wallets. They are thus much less bulky for the pocket. They are also economical inasmuch as the leather covers may be made to do service for several years. We unhesitatingly recommend the Medical Record visiting list as one of the most useful, as well as among the handsomest offered in the market.

Diseases of Infancy and Childhood. By Louis Fischer, M.D., Attending Physician to the Willard Parker and Riverside Hospitals, New York. Second edition. Octavo, pp, 979. With 403 illustrations, several in colors, and 27 full page half-tone and color plates. Philadelphia: F. A. Davis Co. Cloth, $6.50.

A remarkable fact relating to this treatise is that a second edition was called for within six months,-a sure indication of its value. The author is to be congratulated on such signal success. Notwithstanding the sudden demand for a new edition, careful revision has been made even to the extent of changes in many of the articles. Others have been elaborated, as in the treatment of nephritis the salt free diet has been added. Tuberculin innoculation as an aid to diagnosis has been added, and other changes have been made, including new and improved illustrations, bringing it abreast of the immediate present in all essential particulars. It is one of the best textbooks of its kind.

BOOKS RECEIVED.

The National Standard Dispensatory-containing the National History, Chemistry, Pharmacy, Actions and Uses of Medicines, including those recognised in the Pharmacopeias of the United States, Great Britain and Germany, with many references to other foreign pharmacopeias. In accordance with the Eighth Decennial Revision of the U. S. Pharmacopeia, by authorisation of the convention. By Hobart Amory Hare, B.Sc., M.D., Professor of Therapeutics and Materia Medica in Jefferson Medical College, Philadelphia; Charles Caspari, Jr., Ph.G., Phar. D., Professor of Theoretical and Applied Pharmacy in the Maryland College of Pharmacy, Baltimore; and Henry H. Rusby, M.D., Professor of Botany and Materia Medica in the College of Pharmacy of the City of New York; Members of the Committee of Revision of the U. S. P.; New (2d) edition, thoroughly revised. Imperial octavo, 2050 pages, with 478 engravings. Cloth, $6.00, net; full leather, $7.00, net. Thumb-letter index, 50 cents extra. Lea & Febiger, Publishers, Philadelphia and New York.

Modern Medicine. Its Theory and Practice. In original contributions by American and Foreign authors. Edited by William Osler, M.D., Regius Professor of Medicine in Oxford University,

England; formerly Professor of Medicine in Johns Hopkins University, Baltimore; in the University of Pennsylvania, Philadelphia, and in McGill University, Montreal. Assisted by Thomas McCrea, M.D., Associate Professor of Medicine and Clinical Therapeutics in Johns Hopkins University, Baltimore. In seven octavo volumes of about 900 pages each, illustrated. Volume V., Diseases of the Alimentary Tract. Price per volume: cloth, $6.00, net; leather, $7.00, net; half morocco, $7.50, net. Lea & Febiger, Publishers, Philadelphia and New York. 1908.

Progressive Medicine, Vol.X., No.4, December 1908. A Quarterly Digest of Advances, Discoveries and Improvements in the Medical and Surgical Sciences. Edited by Hobart Amory Hare, M.D., Professor of Therapeutics and Materia Medica in the Jefferson Medical College of Philadelphia, assisted by H. R. M. Landis, M.D. Octavo, 333 pages, with 28 engravings. Lea & Febiger, Publishers, Philadelphia and New York. (Per annum, in four cloth-bound volumes, $9.00; in paper binding, $6.00, carriage paid to any address.)

Transactions of the American Otological Society. Forty-first annual meeting, held at Atlantic City, N. J., June 23, 24, 1908. Vol. XI, part 1.. Edited by Dr. J. F. McKernon, Secretary, 62 W. 52d St., New York. Published by the Society. Mercury Publishing Co., Printers, New Bedford, Mass. 1908.

Vaccine 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, etc. Second edition. Octavo, pp. 244. Philadelphia, Pa. Blakiston's Son & Company. 1908. (Price, $2.00, net.)

Transactions of the American Surgical Association. Vol. XXVI. Edited by Richard H. Harte, Recorder. Printed for the Association by William J. Dornan, Philadelphia. 1908.

Report of the Commissioner of Education of the United States for the year ended June 30, 1907. Vol. I. By Elmer Ellsworth Brown, Ph.D., LL.D. Washington: Government Printing Office.

1908.

Cataract Extraction. By H. Herbert, F.R.C.S., late Lieutenant Colonel I. M. S., Professor of Ophthalmic Medicine and Surgery in Grant Medical College, and in charge of the Sir Cowasjee Jehangir Ophthalmic Hospital, Bombay. Otavo, pp. 391. New York: William Wood & Company. 1908.

International Clinics. A Quarterly of Illustrated Clinical Lectures and especially prepared articles on Treatment, Medicine, Surgery, Neurology, Pediatrics, Obstetrics, Gynecology, Orthopedics, Pathology, Dermatology, Ophthalmology, Otology, Rhinology, Laryngology, Hygiene and other topics of interest to students and practitioners. Edited by W. T. Longcope, M.D., Volume IV. eighteenth series. Philadelphia and London: J. B. Lippincott Co. 1908. (Cloth, $2.00.)

MISCELLANY.

A board of commissioned medical officers will be convened to meet at the Bureau of Public Health and Marine Hospital Service, 3 B street SE., Washington, D. C., Monday, January 11, 1909, at 10 o'clock a. m., for the purpose of examining candidates for admission to the grade of assistant surgeon in the Public

Health and Marine Hospital Service. Candidates must be between 22 and 30 years of age, graduates of a reputable medical college, and must furnish testimonials from responsible persons as to their professional and moral character.

The following is the usual order of the examinations: I, physical; 2, oral; 3, written; 4, clinical. In addition to the physical examination, candidates are required to certify that they believe themselves free from any ailment which would disqualify them for service in any climate.

Successful candidates will be numbered according to their attainments on examination, and will be commissioned in the same order as vacancies occur. Upon appointment the young officers are, as a rule, first assigned to duty at one of the large hospitals, as at Boston, New York, New Orleans, Chicago, or San Francisco.

Assistant surgeons receive $1,600, passed assistant surgeons, $2,000, and surgeons, $2,500 a year. The tenure of office is permanent.

For further information, or for invitation to appear before the board of examiners, address "Surgeon-General, Public Health and Marine-Hospital Service, Washington, D. C."

THE United States Civil Service Commission announces an examination on January 13, 1909, at the usual places, to secure eligibles from which to make certification to fill a vacancy in the position of medical interne (female), Government Hospital for the Insane, Washington, D. C., at $600 per annum with maintenance, and vacancies requiring similar qualifications as they may occur in that hospital. The department states that it reserves the right to terminate the appointment at the expiration of one year of service if it is deemed advisable to do so.

ITEMS.

M. J. BREITENBACH Company, 53 Warren Street, New York, importers and distributors of Pepto-Mangan (Gude), have sent out their Physician's Daily Memorandum for 1909. This great house has distributed these books to the profession for several years past, and they have proven one of the most useful articles of the kind for the physician's desk ever gratuitously distributed.

THE Antikamnia Calendar for 1909 presents on the obverse a portrait in colors, of a young girl holding a flower, and is entitled "Purity." On the reverse is the calendar proper, and memoranda relating to antikamnia. It is an exquisite blending of art and business, and will be sent to physicians.

BUFFALO MEDICAL JOURNAL.

VOL. LXIV.

FEBRUARY, 1909.

ORIGINAL COMMUNICATIONS.

No. 7

Prolonged and Tedious Labors and Forceps Deliveries Compared as Causes of Epilepsy, Idiocy

and Cerebral Diplegias.'

BY JAMES WRIGHT PUTNAM, M.D., Buffalo, N. Y,

Professor of nervous diseases, University of Buffalo, Ex-president American Neuro logical Association.

A

STUDY of this question has seemed to me of sufficient importance to make a search of the literature for the purpose of finding the views of various writers in different countries as to the relative proportion of cases caused by these factors.

Epilepsy is so dreadful an affliction and, withal, is so prevalent that any means of lessening the number of its victims is a decided gain for the community. It is estimated that there is cre epileptic for every 1,000 of the population and that would inean 400 in Buffalo.

Idiocy, that state of mental deficiency dating from birth and lasting through life, is an equally great affliction. The census of 1900 places the number of idiots in the United States as 95,000.

Infantile cerebral palsies are those paralytic affections which date from birth. They were originally described by Little of England, and are known generally as Little's Disease. These three conditions may all be the result of meningeal hemorrhage occurring at the time of birth. It is necessary therefore to enquire into the causes of meningeal hemorrhage in infants newly born. Little reported sixty-three cases in all of these abnormal conditions attended the birth. One was born cyanosed; in one, turning was performed; another had the cord turned about the neck; another was a foot presentation and was unconscious for two hours after birth; in all of these there was evidence of pressure and paralysis. In 1882, twenty years later Ross, of England, reported several cases in which the difficulty resulted from foot presentation. In one case there was foot presentation, the labor

1. Read before the Buffalo Academy of Medicine, December 8, 1908.

was difficult and convulsions with the paralysis immediately followed the delivery.

To an American, Dr. Sarah McNutt, belongs the honor of first proving this paralysis was due to meningeal hemorrhage. Her article was published in the American Journal of Medical Sciences, 1885, and has since been quoted by all writers on this subject. Aside from foot presentations, prolonged and tedious labors without the aid of forceps is ascribed as a cause; also labors which were precipitate and labors in which the forceps were used. Asphyxia is assigned as the only cause in many cases. That we may form an opinion as to the relative importance of these, I read the following quotations taken from obstetricians, pediatrists and neurologists.

OBSTETRICIANS.

Dr. Kauffman consulted over forty works on obstetrics for me with reference to quoting them on the question of the comparative harm to the child from the use of forceps, as compared with prolonged difficuit labors. The result of his search was that only one author expressed any opinion on the subject or considered it in any way.

They agree, however, in the four indications for the use of the forceps from the standpoint of the child: (1) forceps should be applied if the pulse is under 100 or over 160; (2) if there are sudden marked violent movements of the child; (3) if meconium appears during head presentation; (4) if there is irreplacable prolapse of the funis. These indications are for the preservation of the life of the child. Indications for the application of forceps with reference to the future mental and physical condition of the child is mentioned by E. P. Davis, of Philadelphia in his treatise on obstetrics, p. 740 to 742:

It is noticeable that most of the cases of congenital epilepsy and idiocy develop in children who were not delivered by forceps, but in whom birth was greatly prolonged, although spontaneous. This illustrates the value of forceps as a conservative instrument and emphasises the fact of the necessity for their proper employment. It also draws attention to the value of other obstetric operations which deliver the mother without the difficult and prolonged passage of the child through the unaltered pelvis.

How this opinion of an obstetrician is held in harmony with clinicians in other specialties these quotations will show. Dr. Van Peyma in a valuable paper read before this academy in 1907, said: It should be known that mutilated, mentally enfeebled, paralytic, and dead children; lacerated, invalided and dead mothers are the ever recurring product of unintelligent and conscienceless obstetric practice.