knowledged to be in accord with natural biological laws; whereas, some methods formerly employed have been proven to be inadequate, if not improper. Hence, in this edition the chapters on practical feeding have been rewritten, while sections on the principles of top milks and the standardisation of gruels have been added. The work now stands at the head of the list on the feeding of infants.

Seven Hundred Surgical Suggestions. Practical Brevities in Surgical Diagnosis and Treatment. By Walter M. Brickner, B.S., M.D., Assistant Adjunct Surgeon, Mount Sinai Hospital, New York; Editor-in-Chief, American Journal of Surgery, Eli Moschcowitz, A.B., M.D., Assistant Physician, Mount Sinai Hospital Dispensary, New York, and Harold M. Hays, M.A., M.D. Third Series. Duodecimo; 153 pages. New York: Surgery Publishing Co., 92 William Street. Price, semi de luxe, $1.00; full library de luxe ooze leather, gold edges, $2.25.

Though this book is small it contains much that is useful. It is of value, in particular, for the junior practitioner and its size is such as to permit it to be carried in the pocket. The topics are classified under marginal headings in red, making any desired subject easy of access. It would be difficult to improve upon the mechanical make-up of the book when its purpose is taken into consideration. If every book, large or small, presented as much material of real value as this one, medical libraries would contain more scientific truth than they do at present.

Clinical Diagnosis and Treatment of Disorders of the Bladder with Technic of Cystoscopy, by Follen Cabot, M.D., Professor of Genitourinary Diseases, Post-Graduate Medical School; Attending Genitourinary Surgeon, Post-Graduate and City Hospitals, New York. 8 vo, 225 pages. Forty-one illustrations, 1 colored plate. Prepaid $2.00. New York: E. B. Treat & Co., Medical Publishers, 241-243 West 23d street, New York.

Here is a small book the object of which is to teach the general practitioner methods of diagnosis and treatment of diseases of the urinary bladder. There is no floundering about in the mazes of high-flown language. It is a simple exposition of the better methods of diagnosis and treatment in conditions which, when they are met with by the general practitioner, are either ignored because of lack of understanding of their importance or entirely overlooked. The cystoscope is given careful consideration and the various instruments and the methods of their manipulation are clearly described.

The chapters on cystoscopic examination might be read to the literary advantage of other writers, for the style is clear, concise and understandable. If the general practitioner reads and takes to heart only those chapters which deal with cystitis and its causes, he will be well repaid for the time expended, for a better, clearer more comprehensive statement of the facts as

bearing on this distressing condition has never been written in any book.

The illustrations deserve a word of praise. They are simply excellent and are neither exaggerated nor overdrawn. The book is small, but it is worth while.

N. W. W.

BOOKS RECEIVED.

The Practical Medicine Series. Ten volumes. Issued under the general editorial charge of Gustavus P. Head, M.D., Professor of Laryngology and Rhinology in the Chicago Post-Graduate Medical School. Vol. I, General Medicine, edited by Frank Billings, M.S., M.D. Head of the Medical Department and Dean of the Faculty of Rush Medical College. Series 1909. Chicago: The Year Book Publishers. (Price, $1.50; entire series, $10.00.)

The Practical Medicine Series. Ten volumes. Issued under the general editorial charge of Gustavus P. Head, M.D., Professor of Laryngology and Rhinology in the Chicago Post-Graduate Medical School. Vol. II, General Surgery, edited by John B. Murphy, A.M., M.D., LL.D., Professor of Surgery in the Northwestern University; Attending Surgeon and Chief of Staff, Mercy Hospital. Series 1909. Chicago: The Year Book Publishers. (Price, $2.00; entire series, $10.00.)

Writing the Short-Story. By J. Berg Esenwein, A.M., Lit. D. Editor of Lippincott's Monthly Magazine. Author of How to Attract and Hold an Audience. Cloth, 12mo, 448 pages. Price, $1.25. Published by Hinds, Noble & Eldredge, New York.

LITERARY NOTES

THE philosophy of long life is interesting to all who believe in the happiness of health, or who are interested in the Emmanuel Movement, or the theories of Metchnikoff and Fletcher. The "Philosophy of Long Life," published this week by John Lane Company, should be a stimulus to all such. Death and life have been the two subjects which have commanded the attention of mankind more than all else from the building of the pyramids to the present. M. Finot looks at life as a force which permeates all things, inanimate objects as well as animals. His conclusion, therefore, is that life is indestructible, and he gives practical suggestions for the prolongation of our life in this world, and for banishing the helplessness of old age. He believes that he has found "The Cure for Old Age," and teaches.calmness in the face of death. The book has run through fourteen editions in France alone, and is being translated into almost every language. It is a philosophy for lovers of life.

THE Modern Medicine Publishing Co., announce for early publication a work on phototherapy entitled Light Therapeutics, a

practical manual: physics, physiologic effects, technic, therapeutics, clinical applications, by Dr. J. H. Kellogg, Superintendent of the Battle Creek Sanitarium. Light Therapeutics will contain about 225 pages and 75 illustrations, printed in large clear type, and substantially bound in cloth. Price, probably, $2.00

net.

Journal of Pharmacology and Experimental Therapeutics is announced. Without rigidly defining the scope of the new journal it may be stated that its pages will be open not only to pharmacologists and workers in experimental therapeutics but also to the representatives of any of the biological or medical sciences who may wish to offer papers that have a close relationship to pharmacological or therapeutical questions.

The Journal will be carried on with the collaboration of the members of the recently organised Society for Pharmacology and Experimental Therapeutics.

In addition, a number of leading men of science in this country and in Europe have promised the new journal their support. At least six numbers of the Journal will be issued yearly and will constitute a volume of not less than six hundred or more than six hundred and fifty pages.

The price of the Journal will be $5.00 per volume, sent postpaid to subscribers in all countries. Contributors will receive one hundred copies of their papers free of charge and additional copies will be furnished at cost.

The first number of the Journal will be issued at an early date about May 1, 1909.

Subscriptions and correspondence concerning business matters should be addressed to THE WILLIAMS & WILKINS PUBLISHING COMPANY, 2427-2429 York Road, Baltimore. Specimen copies of the Journal will be supplied upon application to the publishers.

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, June 14, 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. 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."

BUFFALO MEDICAL JOURNAL.

VOL. LXIV.

JULY, 1909.

No. 12

ORIGINAL COMMUNICATIONS.

Uro-Genital Tuberculosis'

With especial consideration of Tuberculosis of the Bladder

BY BRANSFORD LEWIS, M. D., St. Louis.

N acknowledging my deep appreciation of the honor you have conferred in inviting me to be your guest and essayist this evening, I am expressing the thought that is first and foremost in my mind. I have long looked forward to the time when I could have the opportunity of visiting this mother state, of which we hear so much in our part of the country, and always in words of deep affection,-by your numerous sons who have been lost, strayed or stolen in that direction.

Though never before a visitor in South Carolina, my own Southern blood permitted not the slightest misgiving as to whether I should feel "at home" on arrival here; I only looked forward to the pleasure that I felt was in store for me; of coming face to face with the scenes and birthplace of a large share of American history; of events that thrill the loyal heart of every American citizen. I wanted really to see Fort Moultrie, where Sergeant Jasper replaced the flag, and to become personally acquainted with your metropolis, Charleston, that has occupied the lime light in so many eventful incidents, from cannon balls to earthquakes and, anon, from pills to politics.

But, coming down to the subject that is to engage our attention just now, an easier and clearer conception of uro-genital tuberculosis is obtained, when the general scheme or plan of attack made on these organs by this infection is understood. It is claimed by certain students of this subject that tuberculosis is never primary in the urinary or sexual organs; that, although its first clinical manifestation may be focussed here, the developnient is really secondary to some unrecognised involvement elsewhere, a latent pulmonary lesion, or even a lymph gland.

1. The ad Iress on surgery, delivered before the South Carolina Medical Associa tion, April 21, 1909, at Summerville, S. C.

However this may be, there are certain general plans followed in the development of the infection when it does involve the genitourinary system, that now seem fairly well understood and attested.

Transmitted in any one of five different ways, the tubercle bacilli reach the genitourinary organs (1) through the bloodvessels; (2) through the lymph channels; (3) by means of the physiological secretions, the urine, semen; (4) by continuity of tissue; (5) by contiguity.

Being thus transmitted, it is found that certain organs of the genitourinary system habitually receive the brunt of the attack first, while others invariably stand secondary in this respect. In the vast majority of all cases in which the uro-genital organs are implicated, one or the other kidney is the location of the first attack (never both at the same time); in a very small proportion of such cases one or the other epididymis is the point of initial attack.

From these respective foci extension of the infection spreads in the direction of the physiological secretions (urine and semen); that is, from the kidney downward, along the ureter to the bladder, and from the epididymis upward, along the vas deferens, the seminal vesical ejaculatory duct, prostate to the urethra and vesical neck. Thus the bladder stands in the line of attack from either direction; and therefore stands a most excellent chance of being ultimately concerned in the disease process, no matter from whence it comes.

The determination of these facts (chiefly contributed by Motz and Hallé, Annales des maladies des organes génito-urinaires. 1906, XXIV., p. 161) has finally settled the old time discussion on "ascending and descending infection," as to whether the infection ascended from bladder to kidney, or descended from kidney to bladder. In the presence of infection of both kidney and bladder, it is assured that the kidney is the organ primarily involved, and the extension has been to the bladder, either by the ureter or its lymph ducts. If the infection has come up from the genital gland, the bladder stands in the same secondary relationship also.

In other words, vesical tuberculosis is an affection invariably secondary to tuberculosis of some other uro-genital organ, and must be so considered in respect of diagnosis, prognosis, therapy and management.

Probably we would have difficulty in getting a patient affected with tuberculosis of the bladder to acknowledge that the bladder was "secondary" in any respect. It is usually the most absorbing and vivid exemplification of misery incarnate that he can imagine.