is kept patent by means of a cotton plug. The author disapproves of the promiscuous removal of the lining of the antrum, believing that when this method is used it is seldom necessary.

Nasal Plastic.

Uber Nasemplastiken von DR. HANS KOSCHER. Viener Klinische Wochenschrift, Organ An L. K. Geselschaft Der Arzte in Wien, Dec. 10, 1908, No. 50. Aus der Laryngology Abteilung der Allgemeinen Polliklinik in Wien, (Vorstand) Dr. Koschier.

The author reports two cases operated upon for nasal deformities in which he used with great satisfaction the "Faderl Method." Quoting Faderl from his original article, published 1903, we find the technique as follows: A sieve-like celluloid plate, the size and shape of the skin surface of the nose (Cordate leaf shaped) is implanted in the sub-cutaneous tissue of the forehead, the apex of the plate pointing to and near the root of the nose. After this has become thoroughly incapsulated, the plate is cut around, leaving a margin of about 1⁄2 c. m. excepting at the apex, where it remains attached to the root of the nose. The incision is carried through the skin, subcutaneous tissue and periosteum. The flap thus outlined containing the imbedded celluloid plate is then elevated from the bone and with a little manipulation is given the shape of the nose. The mar gin of the nose having been previously scarified, the flap is sutured into place. The wound on the forehead resulting from the removal of the flap, is drawn together by sutures as much as possible and allowed to granulate.

One of the cases described was a woman 23 years of age. It had been found necessary to remove the nose in an operation for the eradication of Rhinoscleroma. At this operation the celluloid plate was implanted. Four weeks later the flap was cut from the forehead, pressed into shape and sutured into place. The wound on the forehead drawn together and allowed to granulate. The case healed very promptly, resu'ting in a beautiful cosmetic effect.

The other was a man 28 years old with post-leutic nasal deformity. Five weeks after implanting the plate the flap was cut loose, shaped and sutured into place. The union of the flap in this case was by pri"mary intention. Here, too, the result was pleasing, except that the size of the celluloid plate had been misjudged and proved to be a trifle too small. The author found some difficulty in determining the exact size of the celluloid plate. In the first case he used the plate with a narrow, stem-like strip for the support of the septol ridge. This he omitted in the second case and found that the cutaneous band without the celluloid support was just as pleasing. The Faderl's method has several qualities far excelling any of the other Rhino-plastics. The celluloid plate gives a lasting support of the soft tissues, thus prevening the sinking of the newly formed nose. While Frankel has found that celluloid thus imbedded excites but little reaction and is readily tolerated by the tissues, yet wherever a heteroplastic is performed the patient should be warned of the possibility of the sloughing of the tissues.

Propasin, a New and Very Strong Local Anesthetic.

Propasin ein neues, sehr starkes Lokal-anestheticum. von DR. STURMER und DR. LUDERS in Hamburg. Deutsche Medezinische Wochenschrift, December 31, 1908, Berlin.

After much experimenting Paromidobensoachidropylester was gained and found to be of great therapeutic value. To the new compound was given the name "Propasin." It was found to be a very strong local anesthetic, non-irritant and non-toxic and having the same tissue shrinking power as has cocaine. It is a white crystal and flaky powder, neutral in reaction, almost tasteless and odorless. Only slightly soluble in water, but very soluble in alcohol, ether and other organic vehicles, melts at 73 to 70 degrees. Boiled with an alkali, saponifies. As much as 2 grains has frequently been given internally with no ill effects, and its use so far clinically has been very pleasing. A 15 per cent Propasin salve, when applied to the skin, produces first a tickling sensation and later a local anesthesia. The lozenges, each containing 0.012 gr. propasin, used for painful conditions in the mouth and pharynx, have proven very satisfactory. The anodine effect lasting two hours. As many as twelve lozenges can be safely used per day. The drug has proven itself of great use given internally for painful gastric conditions, etc.

Rhinedema with Polyp Formation.

WM. A. HETSCHLER, M.D., Philadelphia. Pennsylvania Medical Journal, August, 1908.

Describes a form of Rinedema not found in literature, and presents the history of two of his cases, and three by Dr. Walter J. Freeman, as examples. The most marked feature of this type is the appearance and disappearance of nasaloedema, with the absence of inflammatory reaction. It occurs in the absence of sinusitis, in some of the cases of nasal secretion was practically absent, while in others it was serious or mucoid in character. The five cases reported were in females, two of which showed marked neurotic tendencies. In three asthma existed, which was relieved by alleviation of the nasal symptoms. Rest in bed, Atropine and Strychnine were of decided benefit in several instances, with complete disappearance of the oedema and polyps. Etiologically the condition seems to be due to a lack of vasomotor control (a condition of hypotension in the blood vessels) the lowering of the circulatory pressure allowing the transudation of the serum with gravity greatly aiding polyp formation.

Dr. Freeman believes that the condition is simply the advance stage of Vasomotor Rhinitis.

Book Notices

The Problem of Age, Growth, and Death. By Chas. S. Minot, LL.D., D.Sc., etc. A Study of Cytomorphosis, Based on Lectures at the Lowell Institute, March, 1907. New York and London: G. P. Putnam's Sons, 1908.

In this work, Prof. Minot attacks the problem of senescence by way of the study of the earliest recognizable manifestations of life, rather than its manifestation in the aged, because "the condition of

old age is merely the culmination of changes which have been going on from the first stage of the germ up to the adult, the old man or woman." Moreover, the decline is more rapid at the earlier period, whence "we must expect from the study of the very young stages to find a more favorable occasion for analysis of the factors which bring about the loss in the power of growth and of change, as the final result of which we encounter the senile organism." He studies first, then, the changes which we find characteristic of old age-decrease in stature, shrinkage and shriveling, lessened functional activity and adaptability, etc. He then discusses the phenomena of cell change-cytomorphosis-which leads him to the conclusion that "differentiation is indeed the fundamental phenomenon of life; it is the central problem of all biologic research, and if we understood fully the nature of differentiation and the cause of it, we should have probably got far along towards the solution of the final problem of the na ture of life itself." Old age is "merely the advanced and final stage of cytomorphosis. *** There is, first, the undifferentiated stage, then the progressive differentiation; next there follows the degenerative change ending in death; and last of all, the removal of the dead cells. Such we may conveniently designate as the four essential stages of cytomorphosis This cytomorphosis is at first very rapid; afterwards it becomes slower. That is a significant thing; the young change fast, the old change s'owly." The main general conclusion of the first part of his lectures, Minot sums up in the following terms: "The growth and differentiation of the protoplasm are the cause of the loss of the power of growth." His next conclusion is that the process of seg mentation of the ovum with which the development of all the animals of the higher type invariably begins is really the process of producing young cells; consequently "rejuvenation is accomp'ished chiefly by the segmentation of the ovum." Minot concludes, in contradistinction to the earlier Embryological view of the ovum as the youngest of cells, that it is really the oldest, derived from the parent body, and presenting the old state of excess of protoplasm to nucleus. On fertilization the nuclei multiply at the expense of the protoplasm, feed on the material stored up in the ovum, and finally become the dormant part of the structure.

"Then begins the other change; the protoplasm slowly proceeds to grow, and as it grows, differentiation follows, and so the cycle is completed. *** The cycle of life has two phases, an early brief one. during which the young material is produced; then the later and prolonged one, in which the process of differentiation goes on, and that which was young through a prolonged senescence, becomes old." Mi. not believes that these are the alternating phases of life, and that as we define senescence as an increase and differentiation of the protoplasm, so we must define rejuvenation as an increase of the nuclear material. Alternation of phases is due to alternation in the proportions of nucleus and protoplasm.

The final outcome of Professor Minot's argument is that death is not a universal accompaniment of life, for it does not, so far as we know, occur as

the natural and necessary result of life in many of the lower organisms, but only as the result of acci dent-some external cause. Therefore, natural death has been acquired during the process of evolution of living organisms as a result of differentiation. The cells passing beyond a simple stage to the more complicated organizations, lose some of their vitality, their power of growth, and possibilities of perpetuation; and, as the organization in the process of evolution becomes higher and higher, the neces sity for change becomes more and more imperative. but it involves its end, and inevitable conclusion, death.

Such is the doctrine which Dr. Minot teaches in this work. It is carefully and conscientiously elaborated, and it would, in the space at our disposal, be obviously impossible even to attempt a criticism. We are only tempted to ask, what is it that starts, or started, the action which eventuates in differentiation and its consequences as here expounded? Surely it must be a self-existent, self-sufficient, selfperpetuating force, either inherent in matter or ex ternal to it. If inherent in matter, it must be subject to limitations, in which case it will contradict its own self-sufficiency. If not inherent in matter, then it must be a "something over,' something external thereto, and we are as far as ever from the solving of the problem of what constitutes life, which Prof. Minot tells us (page 15), is the proper object, the final purpose, of biology. And with this conclusion, if we understand Prof. Minot aright, he would agree, for he reproduces and reiterates in an appendix his address at the American Association for the Advancement of Science, in August, 1879, in which he says:

To explain life we must discover why it displays itself only in a physical basis composed of various albuminoid molecules, imbibed with water and certain salts, and commingled with other complex organic compounds all disposed in a definite order; why this basis divides inte distinct masses, cells, grouped each around a distinct body, the nucleus; why chemical and physical events take place in a particular order in each cell, the regulating power being within the cell itself; why senescence and rejuvenation take place; and finally the source of con sciousness, memory and habit. No mechanical explanation, or theory of conscious automatism suffices, but a vital force is the only reasonable hypothesis; the nature of that force is, for the present, an entire mystery, and before we can expect to discover it we must settle what are the phenomena to be explained by it.

This book is a remarkable study, worthy of the author's reputation. It is pleasing in style, persuasive in argument, clearly earnest in method, and, as far as facts go, a valuable contribution to our biologic knowledge. To us, however, it clearly demonstrates the ultimate dependence of science on philosophy, notwithstanding the contemptuous disregard with which it is the fashion among scientists of these latter decades to regard the study of first causes, or rather of the First-Cause.

Text-Book of Ophthalmology.

By Ernst Fuchs, Professor of Ophthalmology in the University of Vienna. Authorized translation from the eleventh revised and greatly enlarged German Edition. With numerous additions by Alexander Duane, M.D., Surgeon Ophthalmic Institute, New York. With 441 illustrations; 3d edition. J. B. Lippincott Company, Philadelphia and London. Price, $6.00.

Anyone having studied with Prof. Fuchs and be come acquainted with his remarkable personality, can easily comprehend the claim with which this text-book holds us bound. The logical and forceful presentation of each subject force themselves upon

us, as well as their thoroughness. The chapter devoted to the Cornea, 101 pages, is almost a complete treatise of a subject of vital importance. 120 pages are devoted to the Uveal tract, on which subject Fuchs has already so enriched medical literature and which we accept as authority. Other topics are dealt with in as proportionately able a manner. The work is one which would not especially appeal to the average medical student or practitioner, for it embodies so vast a field as to tend to confuse. But as a text-book for one who intends giving special attention to eye diseases, we unhesitatingly recommend it, as well as for a book of reference.

Psychotherapy.

A Course of Reading in Sound Psychology, Sound Medicine and Sound Region. Edited by W. B. Parker. The Center Publishing Company, New York City.

The second number of Psycotherapy is fully up to the standard set by the first number (see Review for Lecember, 1908, for announcement of course). The first article by Richard Cabot on Creative Assertion is a most logical and interesting contribution. The other articles of this number are by J. J. Putnam, M. D.; Rev. L. W. Batten, H. Oppenheim, M. D.; I. H. Coriot, M. D.; R. S. Woodward and Rev. C. A. Place. This number is as attractively printed as its predecessor, and is illustrated with full-page halftones of Paul Dubois, Isidor Coriat and Rev. Chas. гласе.

Principles and Practice of Physical Diagnosis. By John C. DaCosta, Jr., M.D., Associate in Clinical Medicine, Jefferson Medical College, Philadel phia. Octavo of 548 pages, 212 illustrations. Philadelphia and London: W. B. Saunders Company, 1908. Cloth, $3.50 net.

The first section of this work dealing with the methods and technic of physical examination, is somewhat disappointing. The subject is rather a difficult one, but the statements are not all clear and a logical order is not followed. The new methods, however, are discussed in detail, especially instruments of percision.

Section two and three take up examination of the thorax in general and of the broncho-pulmonary sys tem. The clinical anatomy is only briefly touched upon in both sections, and there is a certain amount of overlapping, in part unavoidable. Here again logical order is sacrificed at times for relative importance of signs. There is much of good in these chapters which a more careful arrangement would improve.

Section five deals with the examination of the Cardio vascular system and treats the subject in detail. On the whole, this section is better than the one on examination of the Broncho-Pulmonary system.

Sections four and six are above all the best sections in the book. They deal with the diagnosis of the various Broncho-Pulmonary and Cardio-Vascular diseases.

The clinical pathology is first carefully considered. This is followed by the physical examination, always in logical order, and finally a brief discussion of the differential diagnosis. This is the best discussion of diseases we have seen in any work on Physical Diagnosis,

Section seven deals altogether too briefly with the abdomen, and diseases of the abdominal viscera are not considered in sufficient detail. The illustrations are original and well selected, and the presswork is up to the usual high standard of the W. B. Saunders Company.

"Disorders of the Bladder." "Clinical Diagnosis and Treatment of Disorders of the Bladder with Technique of Cystoscopy," by Follen Cabot, M. D., Professor Genito-urinary Diseases, Post-Graduate Medical School; Attendin Genito-urinary Surgeon, Post-Graduate and City Hospitals, New York. E. B. Treat & Co., Medical Publishers, 241-243 West 23rd St., N. Y. While exhaustive text-books on the subject of Urology are plentiful enough there was undoubtedly a place for a concise and practical work on the technique of Cystoscopy. Cabot had demonstrated his ability to cover the field in so practical a manner as to make it easily understood by those who have not had the opportunity to perfect themselves in the use of the Cystoscope.

The methods suggested for the diagnosis and treatment of the disorders of the Urinary bladder are essentially practical and this statement applies not only to the medical but surgical side of the subject as well.

The perfection of the Cystoscope has made is possible for the general practitioner to take advantage of this practical aid for exact diagnosis of conditions in the bladder.

The reviewer agrees in main with the statements made by the author, though in some instances the reviewer's experiences would suggest some modification of the views contained in this work, for example: He has found Alypin in 2 per cent solution preferable to cocaine as an anesthetic, both on account of the lessened danger, and the fact that anesthesia is prolonged. Attention might have been called more forcibly to the dangers resulting from the use of the Cystoscope in the hands of the inexperienced, both from the standpoint of faulty technique and contra indication. As a whole, however, welcome the work and have already recommended same to advanced students, who are anxious to take up the study of the bladder conditions.

we

The Operating Room and the Patient. By Russell S. Fowler, M. D., Professor of Surgery, Brooklyn Post-Graduate Medical School; Chief Surgeon, First Division German Hospital; Surgeon Methodist Episcopal Hospital, Brooklyn, New York. Second Edition. Revised and Enlarged. Philadelphia and London. W. B. Saunders Company, 1907.

This second edition by reason of the revision and enlargement is an appreciably improved volume. Much new matter has been appended under the head of after treatment.

The book is arranged in twelve chapters devoted to: To Operating Room and Its Personnel; The Instrument and Supply Room; The Instrument and Supply Room (Continued); Anesthesia; The Patient; General Considerations in the After-treatment; Course of Aseptic Wounds, infection; Complications of Wounded Infection; Aseptic Wounds in Infected

Too much praise cannot be given to Dr. Kerley's book on the treatment of the diseases of children. In indications for treatment the author does not content himself with vague, general statements, that a heart stimulant is indicated here or an anti-spasmodic there, but gives the names of his favorite drugs, and, farther, the doses for the different ages. One feels in referring to this work that he has the advantage of having such advice even to minute details, as Dr. Kerley would have given if present. Besides attention to the minutiae of pediatric practice sound common sense is met with cn every side. In short the book is equivalent to a series of lectures on treatment by an eminent authority at the bedside. With Holt for text-book and Kerley for treatment the tribulations of a young practiticner in his first dealings with the sick infants nad children should be greatly modified.

Annual Report of the New York State Hospital. The Eighth Annual Report of the New York State Hospital (year ending September, 1908), for the "Care of Crippled and Deformed Children," has just been received. The hospital, which was established by the legislature in 1900, is situated at West Haverstraw, New York. The report is illustrated, showing the building, grounds and various wards and operating room. The report points out that the institution is a hospital and not an asylum or a school, though the patients are taught reading, writing and a moderate amount of manual training. It is hoped that as the resources are increased this field may be broadened. The hospital is intended "for the care and treatment of any indigent children who may have resided in the State of New York for a period not less than one year, who are crippled or deformed, or are suffering from a disease from which they are likely to become crippled or deformed."

Books, Pamphlets, Etc., Received. From Funk & Wagnalls Co., London and New York: Parcimony in Nutrition. By Sir James Critchton

Browne, M. D., LL.D., F. R. S. Price 75 cents net. From Longmans, Green & Co., New York:

Quain's Anatomy, Vol. III., Pt. 1, Neurology. Containing general structure of the nervous system and the structure of the brain and spinal cord; numerous illustrations, many of which are coored; 11th edition.

From Prof. Irving Fisher, New York:

Economic Aspect of Lengthening Human Life (Delivered before the Ass'n of Life Insurance Presidents, New York, February, 1909).

From Drs. Joseph C. Beck and Emil G. Beck, Chicago:

Toxic Effects from Bismuth Subnitrate by Emil G. Beck (reprint from New York Medical Journal, January, 1909.) Bismuth Paste in the Treatment of Suppuration of the Ear, Nose and Throat. By Joseph C. Beck. (Reprint from Journal A. M. A., January, 1909, Vol. 52, page 117.)

The

From the St. Louis Medical Society, St. Louis Collection of Reprints by Medical Writers. Origin, Purpose and Progress of the Collection with Annual Report of Library Committee and other Memoranda. January, 1909.

From Hinds, Noble & Eldredge, New York City: The Changing Value of English Speech. By Ralcy Husted Bell. A new book, an original book; a book that combines the scientific method with the art that is literary. 304 pages. Cloth, $1.25 postpaid.

From The Surgery Publishing Co., New York: Seven Hundred Surgical Suggestions. By Walter M. Brickner, M. D.; Eli Moschcowitz, M. D.; Harold Hays, M. D. Practical Brevities in Diagnosis and Treatment, Third Series. Price, semide lux, $1.00; ooze leather, gold edges, $2.25. From Irving B. Hayes, Ph. B., M. D., New York: The Anatomical Basis for Successful Repair of the Female Pelvic Outlet (Reprint from American Journal of Obstretics. Vol. LVIII. No. 6, 1908.) From C. H. Hughes, M. D., St. Louis:

Normal Senility and Dementia Senilis. The Therapeutic Staying of Old Age. (Reprint from the Alienist and Neurologist, Vol. XXX, No. 1. Feòruary, 1909.)

From Llewellin Eliot, M. D., Washington, D. C.: Journalistic Suggestions for Medical Writers. (Read before the Medical Society of the District of Columbia, November, 1908.)

From Theo. Groedel, M. D., Bad-Nauheim:

The Nauheim Treatment of Disturbances of the Circulation. (Reprint from the Archives of the Roentgen Ray and Allied Phenomena, Oct., 1908.) The Roentgen-Ray Examination of the Digestive Tract. (Reprint from Archives of the Roentgen Ray and Allied Phenomena, Oct., 1908.)

From the Illinois State Board of Health, Medical Department of the State Government:

Monthly Bulletin-Vo!. IV., No. 10., Nov., 1908, Springfield, Ili.

From Winfield Ayers, M. D., New York City:

On the Use of Wax-Tipped Catheter for Diagnosis of Kidney Stone in the Male. (American Journal of Surgery, Nov., 1908.)

From the New York State Hospital for the Care of Crippled and Deformed Children:

Eighth Annual Report, for the year ending September 30, 1908.

From The American Proctologic Society: Transactions of the enth Annual Meeting, held at Chicago, June, 1908. Edited by Samuel T. Earle, M. D.; Lewis H. Adler, Jr., M. D.

From The Massachusetts General Hospital, Boston' Selected Paper by the Staff. Oct., 1908, Vol. II, No. 1.

COMPLETE SERIES, VOL. LVIII, No. 4 NEW SERIES, VOL. III, No. 4

$2.00 YEARLY

It is with some slight hesitation that I present this communication this evening. Even the suggestion of a new therapeutic agent must rest on more than the observation of a few isolated cases, although the employment of a great many successful therapeutic measures is purely empirical, a rational interpretation of results is always the more satisfactory. I shall first state that the end results here have not been entirely successful, but we have reason to hope for much more with selected and favorable cases. Possibly we may convince you of the soundness of our treatment, and if we are successful you may permit us to continue our observations and assist us in drawing final conclusions when sufficient material has been collected.

Probably the greatest obstacle in the interpretation of our results lies in the lack of uniformity in the conception of the fundamental nature of this disease. This may be demonstrated by reviewing briefly the history' of the development of our knowledge of leukaemia. The disease was first described by Virchow in 1845. His conception of the disease may be best understood by quoting from his original description: "The blood, a tissue in constant development always contains young tissue elements and a fluid intercellular substance. Under normal conditions the great majority of these cells develop into special cells, the haemitin bearing red blood cells. Under abnormal conditions a disturbance of this development takes place, which hinders the formation of the special tissue element and favors a further

*Read before the St. Louis Medical Society. Section Internal Medicine, March 13, 1909.

1 Review History Leukaemia, E. Grawitz, Klinische Pathologie des Blutes, Leipzig, 1906.

development of young cells, the non-specific or simple cells, the so-called colorless corpuscles or lymphocytes." We see, therefore, that Virchow accepted a common origin of the colored and colorless blood cells and considered the leukaemic increase of leucocytes a delayed change of these cells into red blood cells. Pathological changes in the bone marrow were observed by E. Neuman in 1870, and the view that leukaemia was a disease of the spleen lymph glands and bone marrow now became known as the Virchow-Neuman teaching. Vel peau, Bennet and Griesinger and later Kottman, Bard, Renaut and Biondi maintained that leukaemia was a primary disease of the blood. The enlargement of the spleen, bone marrow and the lymphatic apparatus according to these authors lay in an accumulation of the leucocytes and their retention in these organs. In 1878, E. Neuman made an important communication. After a critical review of the entire literature, he concluded that there were. "first, cases of pure myelogenous leukaemia; second, that no case was observed in which the bone marrow was found normal, that no pure case was observed in which the leukaemia originated as a disease of the spleen or of the lymph glands." Neuman came to the important conclusion that every leukaemia was of myelogenous origin. "He distinguished a form of bone marrow disease where the marrow appeared yellow and pus like, which he desig nated a pyoid hyperplasia from another form, from the lymphadenoid hyperplasia where the marrow presented a more grayish red appearance and gelatin like consistency." A new era was then inaugurated by Ehrlich through his cell differentiation based on characteristic staining. In 1898, in conjunction with Lazarus, he differentiated sharply two groups of leukaemia. The one, a lymphatic type, or lymphaemia on account of the great increase of the lymphocytes in the blood, in consequence of a pri mary disease of the lymph glands and a myelo genous leukaemia or myelaemia, where from the marrow, granular cells mixed with erythroblasts. In a short time, contrary to these views appeared those of Walz and Pap penheim. They showed that the sharp separation of the lymphatic form by Ehrlich was not possible; that there were cases in which the

arose