competent observers to possess real merit and to be worthy of a more extended trial at the hands of the profession, have been considered. Indeed, the work is in every particular thorough and accurate, and its title, Modern Materia Medica and Therapeutics, is fully justified. We heartily commend the work to students and practitioners.

THE PRACTICAL APPLICATION OF THE RÖNTGEN RAYS IN THERAPEUTICS AND DIAGNOSIS. BY WILLIAM ALLEN PUSEY, A.M., M D., Professor of Dermatology in the University of Illinois; and EUGENE W. CALDWELL, B.S., Director of the Edward N. Gibbs X-Ray Memorial Laboratory of the University and Bellevue Hospital Medical College, New York. Handsome octavo volume of 591 pages, with 180 illustrations, nearly all clinical. Philadelphia, New York, London: W. B. Saunders & Co. 1903. Cloth, $4.50 net; sheep or half-morocco, $5 50 net.

It has been the aim of the authors of this work to elucidate fully the practical aspects of the subject. It is evident that all the authentic literature which has developed since Röntgen's wonderful discovery has been carefully digested, this being supplemented by the extensive experience of the authors. The value of the X-rays in diagnosis has been discussed in a thoroughly practical manner, and their limitations in this field indicated. Particular atten

tion has been devoted to the use of the X-rays in therapeutics. Nearly all the illustrations in this section represent actual clinical subjects, and show with unusual fidelity the condition before the use of the X-rays, at various stages of their application, and, finally, the therapeutic results obtained. Full details are also given as to the use and management of the apparatus necessary for X-ray work. All the methods with which the best results have been achieved have been carefully described in a comprehensive way. There are chapters on X-ray Tubes, Induction Coils and Controlling Apparatus, Static Machines, Fluoroscopy, Radiography, Photographic Materials Used in Radiography, etc. This section is fully illustrated with instructive photographs and drawings of the apparatus, including four beautiful full-paged colored plates of X-ray tubes. In fact the work will be found of invaluable assistance, not only to the general practitioner, but also to the dermatologist, presenting, as it does, the very latest advances in X-ray therapeutics and diagnosis.

Extracts.

The Modern Therapy of Septic Puerperal and
Surgical Infections.

By ROSWELL PARK, M. D., LL. D.,
Professor of Surgery, University of Buffalo.

(Abstracted from The Alpha Omega Delta Bulletin, March, 1903.) The most efficient measures for the treatment of surgical infections are the various silver preparations, for whose introduction into surgical and obstetrical work we are indebted to Credé, of Dresden. We have been for decades looking in vain for an effective antiseptic which is devoid of marked toxic or irritating properties. Allotropic silver (collargolum) seems to offer us the nearest approach thereto. Between this silver preparation, which is so bland, and the silver salts, like nitrate of silver, there are the lactate and citrate of silver, also introduced by Credé, of which reasonably strong solutions can be used upon quite sensitive surfaces without producing much if any disturbance.

Let us first take the aqueous solution of soluble metallic silver (collargolum) which in the strength of 1 to 500 in distilled water makes a somewhat cloudy solution. In this strength it may be used by intravenous injection in cases of severe general or puerperal sepsis, rapidly spreading gangrene, acute articular rheumatism, or other serious infections. In fact, solutions as strong as 1 to 100 may be employed; it being desirable to introduce 6 cg. (.9 grain) to 10 cg. (1 grains) at least. If there be difficulty in injecting it into a vein it may even be given beneath the skin. Unpleasant effects will not be noticed, neither will any immediate relief, but the solution thus introduced coming into contact with the blood, which, in these cases, is swarming with germs, will promptly begin its bacteri cidal work, whose effects should be manifested after two or three hours by a fall of temperature and amelioration of septic symptoms. Silver used in this way has been of great service in cases of carbuncle, and even of acute anthrax. Moreover, its administration may be repeated as often as may seem necessary.

When metallic silver is made into a suitable ointment (unguentum Credé) which, by the way, much resembles mercurial ointment, and is then applied to the skin, there

is a rapid absorption of the silver itself with its dissemination into the blood stream, and results like those just mentioned. It is simply a somewhat slower method of introducing it into the system. For many years I held and taught that the combination of resorcin, ichthyol and mercurial ointment, which I believe I introduced into surgical practice, was the most effective remedy for the treatment of erysipelas and all similar septic infections. To-day I have found but one combination which I think superior for this purpose, and that is the silver ointment, unguentum Credé. I believe that its properties are more marked than those of the ointment which I so long used. No matter what part of the body be anointed absorption takes place readily and promptly, consequently any convenient surface may be medicated in this way. Cleanse the skin thoroughly, smear the ointment freely over the surface, cover the area with oiled silk, and put over this, if comforting to the patient, a warm application to promote absorption. If the surface be not tender, the ointment may be rubbed in. In cases of puerperal sepsis it may be applied over the abdomen or to the inside of the thighs. In erysipelas it should be applied to the affected part. It makes very little difference what the exact nature of the infection is, one may rely upon it that the silver will be absorbed and will do good work. This is true, for instance, in such acute infections as endocarditis and meningitis.

Advantage may also be taken of the properties of metallic silver by giving it internally as an intestinal or urinary antiseptic, for which purpose it should be given in pills or capsules. These are unirritating and extremely efficient and may be given where remedies like salol, benzozol, etc., are ordinarily exhibited.

Lastly, I would speak of the use of lactate and citrate of silver, not only for such purposes as the preparation of catgut, silk, gauze, etc., but in solutions of from 1 to 300 to 1 to 500 for the irrigation of septic cavities, and for such purposes as washing out the peritoneal cavity in cases of tuberculous peritonitis, for which I have repeatedly used it and always with benefit. I differ from my friend, Dr. Fenger, of Chicago, now dead, who did not favorably regard washing out the abdominal cav

ity in these cases. In my own experience, in several instances, a flushing of that cavity with a 1 to 500 solution has been of the greatest apparent benefit and has never occasioned any regret. Infected bladders, uterine cavities and vaginas may be advantageously, freely and frequently washed out with similar solutions. When using them one may have the feeling that he is using solutions of greater efficacy and of far less toxicity than any of the mercurial preparations would afford. Therein lies the beauty of these preparations, that in anything like equal strength they are more effective and much less toxic than the mercurial salts.

This is a very brief epitome of my views regarding the value of the silver preparations in surgery. I often state in my clinic that the good old-fashioned nitrate of silver is not used nearly so much as it should be, and prove the strength of my conviction by its general use in 1 to 10 per cent solutions in pus cavities. Not only is a full germicidal effect obtained, but also that stimulation to healthy granulation which the nitrate is well-known to afford. All in all, if I could have but one source for antiseptic solutions and applications, I would rather look toward the preparations of silver than in any other direction.

The Composition and Alcoholic Contents of Certain Proprietary Foods for the Sick.

By CHARLES HARRINGTON, M. D., Boston.

Assistant Professor of Hygiene in the Harvard Medical School. In presenting this brief communication, I propose to discuss neither the question of the food value of alcohol nor the advisability of the use of that agent as a remedy in the treatment of disease. It is my intention merely to offer the results of my examination of a number of preparations which are extensively advertised, and, inferentially, widely used, as foods for the sick and for convalescents, and to leave the question of their true nutritive and therapeutic value a matter for independent judgment.

My attention was drawn to this class of preparations by the fact that an invalid who was faithfully following the directions accompanying one of them, was observed to be more or less constantly in a state of marked intoxication, for which condition no cause could be assigned, until the

suspicion was directed to the food, which proved, on analysis, to contain a fairly large percentage of alcohol; and this suggested the advisability of obtaining specimens of other preparations for investigation.

Among those examined were a number which proved to be almost or wholly non-alcoholic, and although their food value was shown to be very slight when their cost was taken into account, they will be passed by without mention.

Of those which I report, it will be noted that the analyses made were not exhaustive, the determination having been restricted to the percentage of alcohol, total solids and mineral matter. The yield of total solids was such in each case as not to warrant the expenditure of the time necessary for an investigation of the nature of the several constituents, and for our present purpose we may concede that the total residue of each preparation is wholly absorbable.

Following are those which were found to contain appreciable amounts of alcohol:

Liquid Peptonoids-" Beef, milk and gluten, perfectly digested" is said to contain the albuminoid principles of beef, milk and wheat. "In cases of feeble digestion and wasting diseases," its effects are said to be "immediate and pronounced."

Dose: For an adult, one or two tablespoonfuls, three to six times daily; children in proportion.

The maximum amount recommended for an adult will yield less than an ounce of nutriment and the alcoholic equivalent of 3.50 oz. of whisky per day.

Analysis shows 23.03 per cent by volume of alcohol, 14.91 per cent of total solids, and 0.17 per cent mineral matter.

Panopepton.-This is said to contain "the nutritive constituents of beef and wheat in a soluble and freely absorbable form." "A nourishing, restorative, stimulant, liquid food of incomparable value for the nutrition of the sick "; "the best food in acute diseases, fevers, etc., in convalescence"; "a restorative from fatigue"; "a special resource against insomnia."

Directions: "For adults, a dessertspoonful to a teaspoonful several times a day and at bedtime; for infants, a