pages, with 46 illustrations. Per volume, $2.50, by express prepaid. Per annum, in four cloth-bound volumes, $10.00. Lea Brothers & Co., Publishers, Philadelphiai and New York.

A glance through this volume will suffice to show the reader the fatuity of attempting to keep up with the progress of scientific medicine unless he can avail himself of such work. The enormous amount of material which it contains is the more astonishing when it is realized that it represents only what is of real, recognized scientific and practical value in current medical literature, and not simply a mass of abstracts of articles which have appeared in magazines. Each of the contributions possesses features which render it especially valuable to every medical man.

The article by Dr. William B. Coley, on the "Surgery of the Abdomen, Including Hernia," cannot be over-estimated. Dr. Clark begins the section of Gynecology with a thorough discussion of all the various phases of cancer of the uterus-its etiology, clinical manifestation and treatment.

Dr. Stengel's section on Diseases of the Blood includes also morbid conditions of the ductless glands and disorder of metabolism.

The section on Opthalmology, edited by Dr. Edward Jackson, is, as usual noteworthy for the practical value which it possesses, not only for the opthalmologist, but for every physician.

The volume is especially copiously illustrate throughout. and the excellent arrangement of its material, together with a full index, render it most convenient for reference. M.

ARCHINARD'S BACTERIOLOGY. A Manual for Students and Physicians. By P. E. Archinard, M. D., of Tulane University Medical Department, New Orleans. In one 12mo volume of 210 pages, with 74 illustrations. Cloth $1.00, net. Lea Brothers & Co., Publishers, Philadelphia and New York, 1903.

The value of an epitome lies in its concise and clear presentation of essentials, thus forming a solid foundation, upon which may be built a sound superstructure of practical knowledge. Judged from this point of view, Dr. Archinard's work is entitled to consideration as a model.

M.

A COMPEND OF HUMAN ANATOMY. By Samuel O. L. Potter, M. A., M. D., M. R. C. P. Lond. Formerly Professor of the Principles and Practice of Medicine in the Cooper Medical College of San Francisco; Author of the "Handbook of Materia Medica, Pharmacy and Therapeutics"; "Quiz-Compend of Materia Medica," "Index of Comparative Therapeutics," and "Speech and Its Defects"; late Major and Surgeon of Volunteers, U. S. Army. Seventh edition, revised and enlarged. With 138 wood engravings; also numerous tables and 16 plates of the arteries and nerves. Philadelphia, P. Blakiston's Sons & Co., No. 1012 Walnut street. 1903. Price, 80 cents, net.

This valuable work has reached its seventh edition, it has been entirely rewritten and brought into harmony with the latest text-books on this subject. The illustrations are excellent. The text, which follows very closely that of Gray, is reliable, designed originally for the use of medical students. The text is confined to the essentials. It is one of the best books of this kind published.

REFERENCE CHART OF "DISEASES of the NERVOUS SYSTEM AND MUSCLES," is the title of a very conveniently arranged booklet prepared by Edward C. Hill, M. Sc., M. D., a member of the faculty of the Medical Department of the University of Denver, published by the Antikamnia Chemical Company, St. Louis. This chart will, it is presumed, be sent to any physician on application.

1

THE COLUMBUS MEDICAL JOURNAL.

VOL. XXVII.

OCTOBER, 1903.

No. 10.

SPECIAL TOPOGRAPHY OF THE URETER AND TRACTUS LYMPHATICUS.

BY BYRON ROBINSON, B. S., M. D., CHICAGO.

Gynecologist to the Woman's Hospital; Consulting Surgeon to the Mary Thompson Hospital, Chicago, Illinois.

The special topographic relations of the ureter to the tractus lymphaticus comprises three factors, viz: (a) The relation of the ureter to the special segment of the tractus lymphaticus-the peritoneum; (b) the relations of the ureter to adjacent lymph nodes; (c) the results of infection on the tractus lymphaticus (especially the peritoneum) from operations on the

ureter.

(A) THE TOPOGRAPHY OF THE URETER AND PERITONEUM.

The topography of the ureter and peritoneum is so important that ureteral surgical operations are named according to whether the operative procedure is extraperitoneal. The ureter lies extraperitoneal in its entire course. It is bound to the peritoneum by fibrous bands so that during cleavage or stripping of adjacent ureteral tissue the ureter will follow the adjacent peritoneum. The ureter is a peritoneal organ as regards movement and nourishment. The ureter is more intimately related to the peritoneum, than any other viscus (except the bladder and kidney). In spare subjects one can observe the ureter shimmering through the peritoneum like a white band for almost its entire course. The ureter is more intimately bound to the peritoneum than the vasa iliaca. In general the proximal ureter is more intimately connected with the peritoneum than the distal. The ureter in its general course is

nearer to the peritoneum than the lumbar or pelvic wall. The ureter is applied to the peritoneum in its entire pelvic extent without an intervening organ, while in the lumbar region the vessels (ovarian and superior and inferior mesenteric) intervene between the ureter and peritoneum, an important matter in the transperitoneal operation on the ureter. In the pelvis the vascular pedicle (umbilical or internal iliac) intervene them

FIG. 1 (Author). The drawing illustrates the ureter in its natural course

selves between the ureter and lateral pelvic wall. The positional relations of ureter, vessels and peritoneum alters methods and results of ureteral surgical intervention. Thus the ureter is safely and easily accessible in the lumbar region by the extraperitoneal route without the ligation or damage of a single important structure. In the pelvis ureteral access by the extraperitoneal route is less favorable. The pelvic ureter can be exposed extra-peritoneally to the bladder, but the operations on its distal and deep in the pelvis would be unsatisfactory

from lack of space to manipulate. Practically the ureter and peritoneum functionate together as in distention and contraction of the pelvic organs and vertical cola. In structure the peritoneum and ureter are intimate as the ureter in cleavage or stripping of the subserosum follows its fibrous connection with the peritoneum. The ureter will glide with the peritoneum over the fixed vessels on the pelvic wall. In general the lumbar ureter is more intimately associated with the peritoneum than the pelvic ureter.

The ureter bears special topographic relations to certain peritoneal structures termed folds, fossa, ligaments or mesenteries which from their importance in diagnosis and surgical intervention should be considered separately as regards topography.

(a) TOPOGRAPHY OF URETER AND LIGAMENTUM LATUM.

The ligamentum latum of all peritoneal folds has the most important topographic relations to the ureter. The relation of the ureter to the ligamentum is that the ureter passes obliquely through its base, but does not lie between the blades of the ligament. The ureter as it passes through the base of the ligamentum practically abandons the peritoneum penetrating deeply into subserosums. The pelvic ureter is the most mobile at the base of the ligamentum latum. During the course of the ureter through the base of the ligamentum latum it crosses dorsal and proximal to the ligamentum teves, the uterer and round ligament are separated by the plexus venosus vesicovaginalis. The ureteral sheath is strong and thick in the base of the ligamentum latum which aids the ureter to withstand the trauma of surgical intervention.

(B) THE TOPOGRAPHY OF THE URETER AND ADJACENT LYMPH

NODES.

In perfect health there are found small lymph nodes distributed on and adjacent to the ureter, especially where the ureter crosses the vasa iliaca. In other words in the iliac segment of the ureter or at the middle arterio-ureteral crossing the lymph nodes are the most prominent and in diseased or hypertrophied condition compromise the ureter lumen by pressure and consequent flexion. In malignant disease, as carcinoma, the distal end of the ureter especially adjacent to