The Therapeutics of the Circulation. Eight Lectures Delivered in the Spring of 1905 in the Physiological Laboratory of the University of London. By Lauder Brunton, Kt., M. D., D. Sc., LL.D. (Edin), LL.D. (Aberd), F. R. C. P., F. R. S., Consulting Physician to St. Bartholomew's Hospital. Published under the auspices of the University of London, pp. 280, with 240 illustrations. Philadelphia, P. Blakiston's Son & Co., 1012 Walnut St., 1908.

This little book attempts to cover in a general way the physiology of the circulation before taking up its therapeutics. The author devotes considerable time to the description of blood pressure apparatus sphygmographs and cardiographs. He then takes up diseases of the heart and arteries both functional and organic. Especial attention is paid to the subjects of nerve condition and self massage of the heart and arteries, both from the physiological and pathological standpoints.

The last three chapters are devoted to the treatmen of circulatory affections. These chapters embody the results of the author's immense experience and contain valuable points not found in many of our text-books. The last 22 pages are devoted to appendices which have as their object, bringing the work up to date, it being three years after their delivery before the lectures were published.

On the whole the book is well worth reading, especially the last three chapters.

The Arteries of the Gastro-Intestinal Tract. Arteries of the Gastro-Intestinal Tract with Inosculation Circles. By Byron Robinson, B. S., M. D., Chicago. The Chicago Medical Book Co.; Price $1.50.

The work on the Arteries of the Gastro-Intestinal Tract with Inosculation Circle by Byron Robinson comprises a series of articles appearing in various medical journals. These segments have been put together in a book of about 200 pages. The book is arranged in five sections. The first section is an introduction by Dr. Thomas G. Atkinson. The second section includes an abstract of the essential view contained in the monograph with special reference to the inosculation circle, and three chapters giving in detail the results of a number of anatomic dissections of the coeliac axis, superior, and inferior mesenteric arteries. Section three describes the arterial fields of the abdomen. Section four considers the applied anatomy and physiology of the inosculation circle. Section five deals with the management of the blood vessels during intestinal resection for syphilitic, carcinomatous or other obstruction of the intestinal

tract.

Any work intended for the advancement of medical science should receive our most hearty encouragement, yet we must weigh facts as they exist. For that reason it seems to the reviewer that the author has gone to a good deal of work to emphasize points anatomically well known. We can mention many representative works, such as Gray, Morris, Piersol, Deaver and Sobotta and McMurrich, which show in their illustrations and describe in their texts most of the anastomoses or inosculations which the author points out.

Bacteriology of the Eye.

By Dr. Theodor Axenfeld, Prof. of Ophthalmology in the University of Freiburg. Translated by Angus Macnab, B. A., B. Sc., M. B., Ch. B., F. R. C. S., Chief Clinical Assistant, Royal London Ophthalmic Hospital. With 87 illustrations, some of which are colored, and three colored plates. New York: William Wood & Co., 1908.

This is the first special book published on Bac

teriology of the eye. Several articles on the subject have appeared in collective text books, such as that by Axenfeld in Kolle and Wasserman's "Handbook of the Pathogenic Micro-Organisms," and Morax, in Graefe-Samish's Handbuch der Gesammtem Augenheilkunde, on Diseases of the Conjunctiva. But here the author has attempted to present the subject for the benefit of both bacteriologist and ophthalmic surgeon and has succeeded in consummating a production which should satisfy him as well as his readers. Great stress has been laid upon the Gram method of staining, almost all of the illustrations showing specimens stained by the Gram or Gram-Weigert method; the three colored plates showing the differentiation of the various commoner micro-organisms staining Gram positive or Gram negative.

There is also a table at the end which differentiates these organisms as to their behavior on media. The order taken in the book is more towards a clinical division than a purely bacteriologic one, which is obviously desirable. That the importance of systematic bacteriological examination of conjunctival secretions and corneal pus, etc., cannot be overestimated, is illustrated by the knowledge that we have a specific in zinc where the Morax-Axenfeld bacillus is found. This is only one example. Quoting the author: "Those who do not fully examine for bacteria in their prac tice will not assist their patients in many of the ways which are possible." No practicing Ophthalmologist can afford to be without access to this book.

A Mind That Found Itself.

An Autobiography by Clifford Whittingham Beers; Longmans, Green & Co., 91 and 93 Fifth Avenue, New York, 1908.

The reviewer has read every line of this remarkable work, and yet he is unable to review it because he has found that no review of it could possibly give an adequate impression of its contents.

The book should be read by every physician; because of the author's keen and accurate analysis of the insane mind; but mainly, because it contains a message to the medical profession concerning hospital and asylum abuses. It should be read by intelligent laymen because the reforms proposed and urgent cannot be accomplished without their cooperation. An intimation of the contents of this work is found in the first paragraph: "This story is derived from as human a document as ever existed; and, because of its uncommon nature, perhaps no one thing contributes so much to its value as its authenticity. It is an autobiography, and more: in part it is a biography; for, in telling the story of my life I must relate the history of another self-a self which was dominant from my twenty-fourth to my twenty-sixth year. During that period I was unlike what I had been, or what I have been since. biographical part of my autobiography might be called the history of a mental civil war, which I fought single-handed on a battlefield that lay within the compass of my skull. An Army of Unreason, composed of the cunning and treacherous thoughts of an unfair foe, attacked my bewildered consciousness with cruel persistency, and would have destroyed me, had not a triumphant Reason finally intersposed a superior strategy that saved me from my unnatural self."

The

Subcutaneous Hydrocarbon Protheses. Subcutaneous Hydrocarbon Protheses. By Strange Kolle, M. D., Author of the Recent Rontgen Discovery, etc., New York; The Grafton Press, New York. Price $2.50.

The surgeon who intends to do this kind of surgery would do well to study this little volume of 152 pages. The author describes in detail the advantages, disadvantages, and dangers of the different methods em

ployed up to the present time. The dangers are numerous and it is incumbent on the surgeon to be acquainted with all of them before he attempts the operation in even a single case. The author has been eminently successful in giving a practical and concise treatise on the subject; describing in detail the requisite apparatus, material, manner of procedure, and technique of the operation.

Especially valuable, however, are his references to untoward results and accidents, though he might have dwelt more on the condition of the patients, years after the operation. The bibliography is excellent.

The book contains eight excellent plates, numerous drawings and the publishers are to be congratulated on the excellency of their work.

Books, Pamphlets, Etc., Received. From J. B. Lippincott Co., Washington, D. C.: Text-Book of Ophthalmology. By Ernest Fuchs. Authorized translation from the 11th revised and greatly enlarged edition, with numerous additions by Alexander Duane, M. D. 441 illustrations, 3d edition. Price $6.00 net. By subscription only.

From Wm. Wood & Co., New York City:

The Bacteriology of the Eye. By Theodore Axenfeld, Professor of Ophthalmology in the University of Freiburg. Translated by Angus MacNab, B. A., B. Sc., M. B., Ch. B., F. R. C. S., Chief Clinical Assistant, Royal London Ophthalmic Hospital. With 87 illustrations, some colored, and three colored plates.

From The Archives of Diagnosis, New York City: The Archives of Diagnosis. A quarterly journal devoted to the study and progress of diagnosis and prognosis. Editor, Heinrick Stern, M. D., New York City. Vol. XI, No. 1, January, 1909. Price 50 cents per copy; $1.00 per annum.

From The Fordham University Press, Fordham, N.Y.: The Crusade Against Tuberculosis. No. 24. Dec. 22, 1908.

From The Center Publishing Co., New York:

Psychotherapy, Vol. I, No. 2. A course of reading in sound psychology, sound medicine and sound religion.

From The Treasury Department, Bureau of Public Health and Marine Hospital Service:

(1) The Present Status of the Leprosy Problem in Hawaii. (2) The Reaction of I epers to Moro's Percutaneous Test. (3) A Note Upon the Possibility of the Mosquito Acting in the Transmission of Leprosy. By Walter R. Brinckerhoff, S. B., M. D., Director, Leprosy Investigation Station, Malakai, Hawaii.

From John W. Marchildon, B. S., M. D., St. Louis: A Comparison of Alcoholic and Watery Extracts in the Serum Diagnosis of Syphilis.

From The New York Lying-In Hospital Press, New York City:

Bulletin of the Lying-In Hospital of the City of New York. Vol. V, No. 2, September, 1908. From Leo M. Crafts, B. L., M. D., Minneapolis: "Medical Education" (reprint from Northwestern Lancet. Sept. 15, 1898).

"Incipient Amyotrophic Lateral Sclerosis With

Recovery." Brachial Neuritis, Angina Pectoris and Epilepsy from Electrical Injury. Traumatic Neuritis and Persistent Brachial Neuralgia from Hypodermic Injection. (Reprint from the Journal of the American Medical Association, February, 1902.)

"The Influence of Ductless Glands Over Metabolism With Illustrated Cases." (Reprint from the Journal of the American Medical Association, January 18, 1908. Vol. I, p. 193.)

"A Fifth Case of Family Periodic Paralysis. (American Journal of the Medical Sciences, June, 1900.)

"Wear and Care of the Nervous System." (Journal of the Minnesota State Medical Association and Northwestern Lancet, November, 1906.)

From J. D. S. Davis, M. D., LL. D., Birmingham, Ala.:

Treatment of Typhoid Fever Perforation. (Reprint from the Amer. Jour. of Obstetrics, Vol. LVIII, No. 6, 1908.)

Rules for Davis Infirmary, 2029-31 Avenue G, Birmingham, Ala.

From Charles Hugh Neilson, M. D., and John W. Marchildon, M. D., St. Louis:

Eosmophilia Produced by Potassium Iodide. (Reprint from the Jour. A. M. A., April 25, 1908. Vol. 1, pp. 135, 1351.)

From Prof. D. O. Nulworm, in Berlin:
Abdruck aus dem Centralblatt fur Bakteriologie,
Parasitenkunde und Infektionskraukheiten.

SURGICAL SUGGESTIONS.

In chronic catarrh, the first suggestion of ethmoidal sinus disease may be the appearance of thick, adherent, stringy mucus in the nasopharynx.-Americal Journal of Surgery.

One should not rely on feeling a tonsil engaged in a tonsillitone; he should see that it is if he does not wish to take the chance of cutting away the pillars of the fauces, a portion of the tongue, the floor of the mouth or the uvula. -American Journal of Surgery.

Small clinging pieces of adenoid tissue which have not been removed by the curette will very likely set up an inflammatory reaction on the posterior pharyngeal wall which is more distressing than the adenoids themselves.-American Journal of Surgery.

Hard foreign bodies in the nose may sometimes be removed, where other means fail, by wiping the cavity and foreign body dry and applying sealing wax attached to cotton.— American Journal of Surgery.

Polypi are not merely cystic tumors-they often spring from a base of diseased bone. Removing the polypi does not cure the disease; the affected bone necessarily must be removed. -American Journal of Surgery.

COMPLETE SERIES, VOL. LVIII, No. 3 NEW SERIES, VOL. III, No. 3

$2.00 YEARLY

Contributed Articles

THE TECHNIQUE OF LOCALIZING FOREIGN BODIES IN THE EYE AND ORBIT BY THE X-RAYS.*

BY R. D. CARMAN, M. D. St. Louis, Mo.

Since first the X-rays were successfully used by Williams in the localization of a foreign body in the eye, the technique has been elaborated and improved commensurately with the general advance of roentgenology.

The method which was employed in the cases to be discussed this evening, is that of Dr. Wm. H. Sweet, of Philadelphia, modified by Dr. Chas. F. Bowen, of Columbus, Ohio, and used in conjunction with the Weeks-Dixon Chart.

In the particular apparatus used the KelleyKoett Mfg. Co. devised the localizing instru ment with its receding spring trigger, localizing stand and clamp for the head, tunnel and plate carrier for the plate (Fig. 1). The tunnel and plate carrier enable us to make two exposures upon one plate, without disturbing the patient or the localizing instrument. This is a splendid improvement over Dr. Sweet's original method where it was necessary to strap the indicators and plate to the patient's head, the exposure being made on two different plates with the patient sitting. This exchange of plates frequently led to error.

Dr. Bowen modified this procedure by placing the patient in a recumbent position, using a small table-like frame to elevate the head, on the lower surface of which he hinged a doorlike plate holder, opening downward, by which means the plates could be exchanged with but slight danger of disturbing the position of either the subject or the indicators.

The Sweet is one of several methods which have triangulation as their basic principle, Dr. Sweet using two metal balls 15 m.m. apart for one of which a cone has latterly been sub

*Adopted from a paper read before the Ophthalmic Section of the St. Louis Medical Society, Feb. 10, 1909.

stituted, and placed a known distance from the eyeball. As will be seen hereafter it is necessary in making measurements upon the negatives, to prolong the axes of the ball and the cone by extending the shadows of their slender rod supports. Hitherto these rods have been made quite short, little more than a half inch, and the accurate prolongation of their shadows was not easy. It occurred to me that by lengthening these rods to one inch the extension of their shadows could be made more exactly, and the instrument thus made which is shown herewith (See Fig. 2), I have found quite convenient.

Two pictures are taken in slightly different planes (Figs. 3 & 4) and from the shadows of the ball and cone, whose positions are known, measurements to the foreign body are made and recorded upon a chart by which the position of the latter is graphically shown at once, without any intricate mathematical calculation.

The patient is required to lie upon the regular compression diaphragm table, the head resting on the localizing stand with the affected eye next to the plate, clamped and steadied with sand bags to prevent motion. The visual axis of the eye should be parallel to the plane of the plate and the eyes fixed upon some object. For this purpose Dr. Bowen uses an object at a distance of about twelve inches. However, in focusing the eyes at such short distance the convergence of the visual axes thus produced disturbs the desired parallelism with the plate, renders it nearly impossible to get the ball-tipped rod in the axis of the eye, and thus leads to error. I have found it advantageous to employ a candle at a distance of about fifteen feet, and an inch or two above the level of the localizing stand. By this means the vis ual axes are rendered approximately parallel to the plate.

With the patient in position and the eyes fixed, the next step is to get the indicators in position.

You will note that, as stated, the ball and cone are 15 m.m. apart, the cone being to the temporal side of the head. The trigger is

set and the ball placed in the center of the cornea so as to exactly indicate the visual axis of the eyeball. This is not difficult with this improved instrument because a notched sight, similar to that used on a rifle has been provided, through which the operator can accur ately align the center of the cornea of the affected eye, and when this has been accomplished the visual axis of the eye, the indicator ball, the notched sight and the objective light fifteen or twenty feet away, will all be in alignment.

The patient is then asked to close the eyes,

and cone or anything else, another exposure is made. Thus the second negative is secured.

Now for the measurements: Upon the first negative a line is drawn in the axis of the rod and ball, which are here superposed, and the visual axis of the eye is thus established. A line is also drawn perpendicular to this and through the center of the foreign body's shadOw. With a millimeter rule is measured the distance of the foreign body above or below the visual axis and said distance in millimeters. laid off upon the front view in the chart, either above or below the center of the cornea and

and the ball is pushed into the lid about the lid's thickness, and the trigger released, when the ball drops back 10 m.m. The patient is then instructed to open the eyes again, and look at the candle, and if everything is in proper position he is told to continue looking at the candle until the exposures are made. In this position the first exposure is made with the ray perpendicular to the plate and parallel to the plane of the indicators. Thus the first negative is secured.

The tube is then shifted toward the patient's feet four or five inches and tilted slightly; the plate is changed and without moving the ball

above or below the point representing the position of the cone. A line is drawn through these indicated points on the chart.

Likewise upon the second negative, lines are drawn through the axis of the ball and the axis of the cone, and a perpendicular to these through the foreign body. Then with the mil limeter rule the distance of the foreign body above or below the prolonged axis is measured.

These distances are also recorded upon the front view in the chart, at the proper points, and a line is drawn through these points.

The intersection of this line with that made from the first negative will represent the loca