BARNES ON WOMEN. A CLINICAL HISTORY OF THE MEDICAL AND SURGICAL DISEASES OF WOMEN. By ROBERT BARNES, M.D., Examiner in Obstetrics and the Diseases of Women at the University of London and the Royal College of Surgeons; Obstetric Physician and Lecturer on Obstetrics and the Diseases of Women to St. Thomas's Hospital, &c. With One Hundred and Sixty-nine Illustrations. In one very handsome octavo volume of about 800 pages: cloth, $5 00; leather, $6 00. There has seldom appeared in the English in midwifery practice. The work which has just language a more complete, thorough, and ex-issued from his pen will go far to establish him haustive treatise on any medical subject than as an equal authority in the special department the one now under notice. Dr. Barnes had al- of practice of which he treats. We can only reready established for himself, by his writings peat that, as a thoroughly sound, practical, clinand his practice, a position second to none as au ical treatise, we know of no English work which obstetric authority. He has had probably the can compare to this of Dr. Barnes. To the solargest operative midwifery experience of any called specialist, as well as to the general pracliving practitioner, and his name is associated titioner, it will prove a most useful guide.—The with some of the most important improvements London Lancet, Jan. 10, 1874. BELLAMY'S SURGICAL ANATOMY. THE STUDENT'S GUIDE TO SURGICAL ANATOMY: Being a Description of the most Important Surgical Regions of the Human Body, and intended as an Introduction to Operative Surgery. By EDWARD BELLAMY, F.R.C.S., Senior Assistant Surgeon to Charing Cross Hospital, etc. With Fifty Illustrations. In one handsome royal 12mo. volume; cloth, $2 25. Hitherto there has been no handbook by any English teacher on surgical-or, as Mr. Bellamy terms it-"Applied Anatomy." The anatomical descriptions are, as might be expected from the author's experience as a teacher of anatomy, re liable and good. On the whole, the book is a very creditable performance, and we cordially congratulate Mr. Bellamy upon having produced | it.-Lond. Med. Times and Gaz., Dec. 27, 1873. JUST ISSUED. DUNGLISON'S MEDICAL DICTIONARY. MEDICAL LEXICON; A DICTIONARY OF MEDICAL SCIENCE Containing a Concise Explanation of the various Subjects and Terms of Anatomy, Physiology, Pathology, Hygiene, Therapeutics, Pharmacology, Pharmacy, Surgery, Medical Chemistry, Obstetrics, Medical Jurisprudence, and Dentistry; Notices of Climate and of Mineral Waters; Formulæ for Officinal, Empirical, and Dietetic Preparations; with the Accentuation and Etymology of the Terms, and the French and other Synonymes. By ROBLEY DUNGLISON, M.D., Late Professor of the Institutes of Medicine, &c., in Jefferson Medical College, Philadelphia. A New Edition. Enlarged and thoroughly Revised, by RICHARD J. DUNGLISON, M.D. In one very large and handsome royal octavo volume of about 1150 pages: cloth, $6 50; leather, with raised bands, $7 50. A book well known to our readers, and of which every American ought to be proud Phila. Med. Times, Jan. 3, 1874. In no former revision have the alterations and additions been so great. More than six thousand subjects and terms have been added.-Cincinnati Clinic, Jan. 10, 1874. GRIFFITH'S UNIVERSAL FORMULARY. A UNIVERSAL FORMULARY: Containing the methods of Preparing and Administering Officinal and other Medicines. The whole adapted to Physicians and Pharmaceutists. By ROBERT E. GRIFFITH, M.D., &c. Third Edition, thoroughly Revised, with Numerous Additions. By JOHN M. MAISCH, Professor of Materia Medica in the Phila. College of Pharmacy. 1 vol. 8vo. pp. 789: cloth, $4 50; leather, $5 50. It is one of the most useful books a country We are not cognizant of the existence of a parpractitioner can possibly have in his possession. allel work.-London Med. Gazette. -Medical Chronicle. LEISHMAN'S MIDWIFERY. A SYSTEM OF MIDWIFERY; Including the Diseases of Pregnancy and the Puerperal State. With 182 Illustrations. By WILLIAM LEISHMAN, M.D., Professor of Midwifery in the University of Glasgow, &c. In one large and very hand. some octavo volume of over 700 pages: cloth, $5; leather, $6. We know not where in any system of obstetrics to find a compendium so full and so entirely up to the knowledge of the day.-Phila. Med. Times, Oct. 25, 1873. Unquestionably the best modern book on Midwifery in our language.-Brit. and For. Med.Chir. Review, Oct. 1873. HENRY C. LEA-Philadelphia. 66 CLINICS. CLINICAL LECTURES. Pyaemia in Private Practice.-PRESCOTT HEWETT, Senior Surgeon to St. George's Hospital, relates some most interesting gleanings from private practice, "the clinical results of which," he observes, may be made valuable, and all the more so when contrasted with those of hospital practice: and the subject to which I shall direct your attention is that of Pyæmia, a subject than which none is more important, and the consideration of which, in some of its bearings, has of late years been largely occupying the attention of our profession. The few observations which I have now to offer you on this subject will be confined to cases occurring in private practice. "A young lady, aged 15, stoutish, but of good general health, came under my care for a congenital cystic tumour at the root of the neck. When an infant, an attempt had been made to remove this tumour, but a bit of it was left, as it was closely adherent to the large vessels. For several years after this operation nothing was noticed in relation to this tumour, but for two or three years previously to seeing my patient it had, without any apparent cause, taken to growing; and when I was consulted it occupied the whole of the lower part of the left side of the neck, and projected beyond the clavicle. At a consultation, with the late Mr. Keate, who had performed the operation, it was determined that singlethread setons should now be used, and two of these were introduced into the tumour. In a few days intense inflammation set in, and suppuration followed; a quantity of matter was let out, the Published monthly by HENRY C. LEA, Nos. 706 & 708 Sansom Street, Philadelphia, for One Dollar a year; also, furnished GRATUITOUSLY to all subscribers of the "American Journal of the Medical Sciences," who remit the Annual Subscription, Five Dollars, in advance, in which case both periodicals are sent by mail free of postage. In no case is this periodical sent unless the subscription is paid in advance. VOL. XXXII.—3 swelling subsided, and for some days | quently followed by pyæmia and death. everything appeared to be going on satis- As far as one could judge, the conditions factorily; then came rigors and sweating, under which this trival operation was but without any increase in the local performed were all favourable ones. The trouble. After awhile it became evident patient, middle-aged, and not stout, had that the patient was suffering from some months previously undergone, withpyæmia, the mischief being in the left out a bad symptom, a similar operation lung, and for several days the condition for the removal of three other sabaceous was most perilous; but one afternoon, tumours. The bedroom, in a house in after a violent fit of coughing, a large one of our most open and healthiest quantity of offensive matter was suddenly squares, was large and well ventilated; brought up, after which the more dan- the weather was temperate, and the patient gerous symptoms gradually subsided, had remained in the house after the opeand the patient ultimately recovered, ration. and remained perfectly well, without any further trouble as to the tumour. In this case the patient's room-large, lofty, and well ventilated-was in a wellfound house in one of the best streets in town. "A hale old gentleman, close upon 80, who had long enjoyed must excellent health, had a small warty growth in the skin, just over the insertion of the tendo Achillis. This growth I removed, as it constantly became chafed, and troubled him much in walking. I made him lay himself up for a few days, and then, as the trifling wound was all but healed, he was allowed to go about a little, but, being of very active habits, he one day took a longer walk than usual. This was followed by some slight inflammation of the wound, which, however, soon sub sided, and he was on the eve of returning to his usual avocations when rigors and sweating made their appearance; then came an immense deep-seated abscess in the thigh, under the constant draining of which he ultimately sank. "I was called in consultation to a gentleman who was suffering from pyæmia, and who a short time before had had a small wart removed from the scrotum. He died. Details of this case are given further on, as I had to attend this gentleman between three and four years previously for a former attack of pyæmia. "I operated upon a middle-aged lady, of good general health, for scirrhus of the breast, and for the first eight days everything looked promising; then came a rigor, followed by erysipelas around the wound, which for a few days went on slowly spreading; subsequently pyæmia made its appearance, and under this she gradually sank. The house in which the operation was performed was in one of the best streets in Pimlico. The bedroom was of good size, and well ventilated. "About a month afterwards I operated upon another lady for scirrhus of the breast. Middle-aged and slim, she was of a sallow complexion, but in good general health. In this case, too, everything promised well for the first few days; then came a severe rigor and sickness; erysipelas soon made its appearance around the wound, whence it gradually spread. Matters went on thus for a few days; then there was pyæmia, and in a few days more the patient was dead. In this case, the operation was performed a few miles out of town. The bedroom, very large and well ventilated, was in a large well-built house, with all modern appliances, and situated on a heath, on elevated ground, overlooking a wide expanse of country. As far as one could judge, no better or healthier situation could have been selected for an operation. "A lady, aged about 45, had a large sero-cystic tumour of the breast, some of the cysts of which occasionally suppurated, and were, under such circumstances, sometimes opened and sometimes allowed to burst. Matters went on thus, as she would not hear of an operation, for between eight and nine years, the general health being as good as ever between the attacks. At this period a small cyst suppurated, and was allowed to burst, shortly after which erysipelas made its appearance round the edges of the little sore; then in a few days came rigors and sweating, with pain and great swelling of one of the knee-joints, and in a few days more this lady sank. At the time of the bursting of the cyst the patient was in her usual good health; her bedroom, fair sized and well ventilated, was in a house in a part of town generally considered to be one of the healthiest. "A young gentleman met with an accident to his shoulder, which led to inflammation of the joint, and for this he ultimately consulted me. After awhile the inflammation subsided, leaving the joint somewhat stiff. Then, persuaded by some friends, he went to a bone-setter, who pronounced that the bone was out, and proceeded to put it back, as he said. The manipulations gave him great pain, and were followed by a recurrence of inflammation in the joint, for which he once more fell under my care. Suppuration of the joint ensued, and abscesses burst in various directions. Thus matters went on for a time, then came rigors, profuse sweatings, and a sodden appearance of the skin, with an anxious countenance, a running pulse, and great loss of flesh the joint itself and the parts around it being meanwhile without any increase of mischief. Although tall and slim, this gentleman, up to the time of going to the bone-setter, had been in good health, and his family was healthy. He remained in this perilous condition for some time, looking as if secondary abscesses might occur at any moment. All this time he lived out of town, in a good country house, well cared for, and with plenty of fresh air. With the winter coming on, I sent him to the south of France, where, after a residence of some months, the more threatening symptoms gradually subsided, and when he returned to this country there was a decided improvement in his general health; but he was still far from well, and he remained more or less ailing for between two and three years, at the end of which period he was in fair health, with a permanently stiff joint, the abscesses about the shoulder having gradually dried up. "A middle-aged lady, in fair health, was supposed to be suffering from a sharp attack of sciatica on the right side, and for this she was ultimately sent to Wiesbaden; but after a time, finding that there was no improvement as to the pain, she returned home, and for some months went on creeping about, under the supposition all the while that she was suffering from sciatica. It was at this period that I was consulted on account of a swelling which had been gradually making its appearance in the corresponding groin. The swelling proved to be an abscess which extended into the iliac fossa; and, on further investigation, the sacro-iliac joint was found to be the source of all the trouble. The abscess was allowed to burst, after which everything went on satisfactorily for some three weeks, when pyæmia made its appearance, and was followed by death in a week. This lady lived in a house on a hill, a few miles out of town. house was in every respect well found, and her bedroom was airy and well ventilated. The "I was telegraphed for a few miles out of town to a gentleman about thirty years of age, who was thought to be suffering from acute inflammation of both anklejoints, and inflammation of the left lung. The case, on closer examination, proved to be one of pyæmia, in connection with suppuration about the tonsils. In a few days, the inflammation around the anklejoints ended in the formation of matter, which was let out; after which this patient pradually recovered, and in a few weeks was restored to his usual good health. This case has already been alluded to as that of the gentleman who died of pyæmia after a trifling operation for the removal of a small wart from the scrotum. Between the two attacks of pyæmia in this case, there was an interval of between three and four years. The first attack occurred in the country, and the second in town. "Recently, too, I have seen another gentleman, who, in connection with suppuration about the tonsils, had symptoms of poisoned blood-rigors, profuse sweat, sodden skin-under which he sank. "A young gentleman, aged 18, had a severe attack of typhoid fever, from which, however, he was making a good recovery, when, about a fortnight after all symptoms had disappeared, he again became feverish, and soon afterwards, without having met with any accident, he complained of pain along the shin-bone; swellings, which were very painful, formed along the surface of the bone; suppuration followed; the abscesses were opened, and went on discharging for some time, after which they gradually dried up without further mischief. "A lady's maid, aged about 30, had a severe attack of typhoid fever in the country. She recovered, and, being considered convalescent, came up to town, shortly after which smart feverish symptoms made their appearance, and were soon followed by swelling, affecting principally the knee, and extending some distance down the front and inner side of the leg. For awhile the symptoms were very severe, and ended in extensive suppuration about the upper part of the tibia; the matter was let out, and the patient gradually recovered; but the free use of the limb was not regained for a couple of years, and during this period several bits of bone came away. “A delicate middle-aged lady had typhoid fever, which in due course passed away, leaving her weak and ailing, with now and then a recurrence of slight feverishness. After a time, this feverishness became more marked, and then she began to complain of very severe, deep-seated pains in various parts; first, at the upper and inner side of the tibia; then, at subsequent periods, over the lower part of the shoulder-blade, along the middle part of the spine, over the ribs, as well as over the crest of the haunch-bone. The pain in each of these parts was followed by swellings, and ultimately by abscesses, some of which were large and deep-seated. The abscesses were allowed to burst, and then, after the subsidence of the swelling, a probe was, in each instance, easily passed down to the periosteum, and in some parts the bone was found bare. The drain was great; hectic set in; and, after intense suffering, with occasional but limited mischief about the lungs, this lady sank, "A delicate-looking girl, aged 18, ran a needle into the fleshy part of the leg, where it broke off, but could be felt projecting slightly beyond the skin. It was pulled out, and she went about her work as usual; but in a few days the tiny wound festered, and in a few days more she was admitted into St. George's Hospital with symptoms of pyæmia, rigors, profuse sweatings, and swellings in various parts. Subsequently came evident signs of mischief about the lungs, and she sank within a month after the trifling injury. The needle, according to the patient's account, was quite clean; and she stated that she had never been laid up before, and had always had good health. "A young gentleman, aged 18, and apparently in good health, whilst bathing, ran a small splinter of wood into the fleshy part of the great toe. The splinter was immediately plucked out, and he went about as usual for several days, as if nothing had happened. Then the spot became painful, and a tiny abscess formed; it was attended to, but in a few days it was followed by urgent symptomssevere rigors and most profuse sweatings; abscesses formed in the leg-one, a very large one, was deep-seated and in the calf; as they appeared they were dealt with, but for weeks the sweatings were so profuse that it was necessary to change the bed-linen several times in the twenty-four hours. Ultimately, however, the patient recovered, and he left his bed, a mere skeleton, between four and five months after the onset of the attack. His bedroom was fair-sized, well ventilated, with a large window looking over a wide expanse of country, the house, a recently built one, being on the outskirts of a town. "A gentleman, middle-aged, was tripped |